From the Guidelines
An upper GI barium swallow can be used to evaluate the cause of difficulty swallowing, particularly when endoscopy is not possible or when structural disorders require further scrutiny. This diagnostic test involves drinking a contrast material (barium) while X-rays are taken to visualize the esophagus, stomach, and upper part of the small intestine. The barium coats the lining of these organs, making structural abnormalities visible on X-ray images. According to the British Society of Gastroenterology guidelines 1, barium swallow should be considered where endoscopy is not possible and/or where structural disorders require further scrutiny.
Some of the key causes of swallowing difficulties that can be detected by an upper GI barium swallow include:
- Strictures (narrowing)
- Webs
- Rings
- Diverticula (pouches)
- Tumors
- Motility disorders
- Hiatal hernias
As noted in the ACR Appropriateness Criteria 1, the biphasic esophagram permits detection of both structural and functional abnormalities of the esophagus, with a sensitivity of 96% in diagnosing cancer of the esophagus or gastroesophageal junction. While endoscopy is the preferred investigation in patients with oesophageal dysphagia, an upper GI barium swallow can be a useful adjunct to endoscopic examination, particularly in situations where endoscopy is not possible or when structural disorders require further scrutiny 1.
It is essential to note that the barium swallow may not fully evaluate functional swallowing disorders, for which a modified barium swallow (videofluoroscopy) performed with a speech pathologist might be more appropriate. The test is generally safe with minimal radiation exposure, though patients who are pregnant should inform their doctor beforehand. Overall, an upper GI barium swallow can be a valuable diagnostic tool in evaluating the cause of difficulty swallowing, particularly in certain situations where endoscopy is not feasible.
From the Research
Evaluation of Difficulty Swallowing using Upper GI Barium Swallow
- The upper GI barium swallow can be used to evaluate the cause of difficulty swallowing, but its usefulness is limited compared to other diagnostic tools such as endoscopy and esophageal manometry 2.
- According to a study published in the Journal of the Canadian Association of Gastroenterology, barium esophagram may be useful when the availability of endoscopy is limited, but endoscopy is recommended over barium esophagram for the assessment of structural and mucosal esophageal disease 2.
- Another study published in Gastroenterology discusses the current approach to diagnosis and therapeutics of various esophageal motility disorders, highlighting the importance of high-resolution esophageal manometry in detecting achalasia and other motility disorders 3.
- A study published in The Surgical Clinics of North America focuses on upper esophageal dysphagia, stating that diagnosis is made from imaging or endoscopic studies, and treatment is frequently accomplished endoscopically 4.
- The causes of upper esophageal dysphagia include anatomic changes, strictures, cricopharyngeal hyperfunction, and Zenker diverticulum, which can be evaluated using imaging studies such as upper GI barium swallow 4.
Diagnostic Approach
- The diagnostic approach to difficulty swallowing involves identifying oropharyngeal dysphagia promptly due to the risk of aspiration, and then assessing esophageal dysphagia using history, physical examination, and endoscopy 2.
- Esophageal manometry is recommended for the diagnosis of esophageal motility disorders, with high-resolution manometry being preferred over conventional manometry 2.
- The choice of diagnostic tool depends on the availability of resources and the specific clinical presentation of the patient 2.