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Barium Swallow (Esophagography)

Definition

Barium swallow
, also known as esophagography, is the radiographic or fluoroscopic examination of the pharynx and the fluoroscopic examination of the esophagus after ingestion of thick and thin mixtures of barium sulfate.
This test, is commonly performed as part of the upper GI series, is indicated for patients with history of dysphagia and regurgitation. Further testing is usually required for a definitive diagnosis.
After the barium is swallowed, it pours over the base of the tongue into the pharynx. A peristaltic wave propels it through the entire length of the esophagus in about 2 seconds. When the peristaltic wave reaches the base of the esophagus, the cardiac sphincter opens, allowing the barium to enter the stomach. After passage of the barium, the cardiac sphincter closes. Normally, it evenly fills and distends the lumen of the pharynx and esophagus, and the mucosa appears smooth and regular.

Purpose
  • To diagnose hiatal hernia, diverticula, and varices.
  • To detect strictures, ulcers, tumors, polyps, and motility disorders.

Procedure
Patient Preparation
  1. Explain to the patient that this test evaluates the function of the pharynx and esophagus.
  2. Instruct the patient to fast after midnight before the test.
  3. If the patient is infant, delay the feeding to ensure complete digestion of the barium.
  4. Explain that the test takes approximately 30 minutes.
  5. Describe the milkshake consistency and chalky taste of the barium preparation the patient will ingest; although it’s flavored, it may be unpleasant to swallow.
  6. Tell him he’ll first receive a thick mixture and then a thin one and that he must drink 12 to 14 oz (355 to 414 ml) during the examination.
  7. Inform him that he’ll be placed in various positions on a tilting radiograph table and that radiographs will be taken.
  8. If gastric reflux is suspected, withhold antacids, histamine-2 (H2) blockers, and proton pump inhibitors, as ordered.
  9. Just before the procedure, instruct the patient to put a hospital gown without snap closures and to remove jewelry, dentures, hairpins, and other radiopaque objects from the radiograph field.
  10. Check the patient history for contraindications to the barium swallow, such as intestinal obstruction and pregnancy. Radiation may have teratogenic effects.
Implementation
  1. The patient is placed in an upright position behind the fluoroscopic screen, and his heart, lungs, and abdomen are examined.
  2. The patient is instructed to take one swallow of the thick barium mixture; pharyngeal action is recorded using cineradiography.
  3. The patient is instructed to take several swallows of the thin barium mixture. Passage of the barium is examined fluoroscopically; spot films of the esophageal region are taken from lateral angles and from the right and left posteroanterior angles.
  4. To accentuate small strictures or demonstrate dysphagia, the patient may be asked to swallow a “barium marshmallow” (soft white bread soaked in barium) or a barium pill.
  5. The patient is then secured to the X-ray table and rotated to trendelenburg position to evaluate esophageal peristalsis or demonstrate hiatal hernia and gastric reflux.
  6. The patient is instructed to take several swallows of barium while the esophagus is examined fluoroscopically; spot films are taken.
  7. After the table is rotated to a horizontal position, the patient takes several swallows of the barium so that the esophageal junction and peristalsis may be evaluated.
  8. Passage of the barium is fluoroscopically observed and the spot films are taken with the patient in the supine and prone position.
  9. During fluoroscopic examination of the esophagus, the stomach and the duodenum are also carefully studied because neoplasms in these areas may invade the esophagus and cause obstruction.
Nursing Interventions for Barium Swallow
  1. Check the additional films and fluoroscopic evaluations haven’t been ordered before allowing the patient to resume his usual diet.
  2. Instruct the patient to drink plenty of fluids, unless contraindicated, to help eliminate the barium.
  3. Give cathartic as prescribed.
  4. Tell the patient to notify the physician if he fails to expel the barium in 2 to 3 days.
  5. Inform the patient that stools will be chalky and light colored for 24 to 72 hours.

Interpretation
Normal Results
  • The swallowed barium bolus pours over the base of the tongue into the pharynx.
  • A peristaltic wave reaches the base of the esophagus, the cardiac sphincter opens, allowing the bolus to enter the stomach. After the passage of the bolus, the cardiac sphincter closes.
  • The bolus evenly fills and distends the lumen of the pharynx and esophagus, and the mucosa appears smooth and regular.
Abnormal Results
  • Barium swallow may reveal hiatal hernia, diverticula, and varices.
  • Strictures, tumors, polyps, ulcers, and motility disorders, such as pharyngeal muscular disorders, esophageal spasms, and achalasia (cardiospasm) may be detected.

Complications
  • Barium retained in the intestine may harden, causing obstruction or fecal impaction.
  • Abdominal distention and absent bowel sounds, which may indicate constipation and may suggest barium impaction.

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