From the Guidelines
A modified barium swallow is the preferred diagnostic imaging procedure for evaluating oropharyngeal dysphagia with an attributable cause, as it allows for real-time assessment of swallowing safety and effectiveness of compensatory strategies 1. When deciding between a barium swallow and a modified barium swallow, it is essential to consider the specific symptoms and conditions being evaluated.
- A barium swallow (also called an esophagram) primarily evaluates the esophagus and is used to detect structural abnormalities like strictures, masses, hiatal hernias, or reflux.
- In contrast, a modified barium swallow (videofluoroscopy) focuses on the oral and pharyngeal phases of swallowing and is performed with a speech-language pathologist present. The patient consumes barium of various consistencies (thin liquid, nectar, honey, pudding) while seated, and the procedure evaluates for aspiration risk, swallowing dysfunction, and effectiveness of compensatory strategies 1. Choose a barium swallow when investigating esophageal symptoms like dysphagia, heartburn, or regurgitation. Select a modified barium swallow when concerned about aspiration, neurological swallowing disorders, or when evaluating patients with conditions like stroke, Parkinson's disease, or head and neck cancer who have difficulty initiating swallowing 1. The modified version is particularly valuable for developing treatment strategies for patients with dysphagia as it allows real-time assessment of swallowing safety with different food textures. According to the American College of Radiology, a fluoroscopy barium swallow modified is usually appropriate for the initial imaging of oropharyngeal dysphagia with an attributable cause 1.
From the Research
Comparison of Barium Swallow and Modified Barium Swallow
- The modified barium swallow (MBS) and the functional endoscopic evaluation of swallowing (FEES) are both valuable procedures for evaluating dysphagia, showing good agreement with diagnostic findings related to tracheal aspiration, laryngeal penetration, pharyngeal residue, diet level, and compensatory swallow safety strategies 2.
- A study comparing the effectiveness of fiberoptic endoscopic swallow study and modified barium swallow study techniques in diagnosis of dysphagia found that MBS was more efficacious in detecting aspiration and pooling in the vallecula in patients with neurogenic dysphagia, while FEES was better at evaluating internal anatomy, visualization of masses, and laryngopharyngeal sensory discrimination 3.
Advantages and Disadvantages of Each Procedure
- The MBS has advantages in dynamic evaluation of the oral and esophageal phases of swallowing, as well as detection of esophageal pathologies 3.
- The FEES has advantages in detection of aspiration, visualization of pharyngeal and laryngeal swallowing anatomy, and residue 3, 4.
- However, clinicians may provide more severe interpretations of residue amount on FEES, suggesting that FEES is a more sensitive tool than MBS studies 4.
Diagnostic Capabilities
- The MBS is a dynamic technique designed to evaluate swallowing function and dysfunction as it relates to the oral and pharyngeal phases of swallowing 5.
- The conventional barium swallow assesses structure and function of the thoracic esophagus, including gastroesophageal reflux and its sequelae, while the modified barium swallow evaluates swallowing function and dysfunction 5.
- A study found that clinicians reported a significant difference in the visualization of anatomical sites, with 11 of the 15 sites reported as better-visualized on the FEES than on the MBS video 4.