- What To Expect Before Your CT Scan
- Why is barium used during some X-ray tests?
- Types of barium test
- What preparation do I need to do?
- After you have had a barium X-ray test
- Are there any side-effects of a barium x-ray?
- Some other points about barium X-ray tests
Barium Sulfate oral suspension
- What is this medicine?
- What should I tell my health care provider before I take this medicine?
- How should I use this medicine?
- What if I miss a dose?
- What may interact with this medicine?
- What should I watch for while using this medicine?
- What side effects may I notice from receiving this medicine?
- Where should I keep my medicine?
- Barium swallow and barium meal
- What to Expect from Your Barium Swallow Test
- During the Test
- Possible Side Effects
- Upper GI Series Preparation, Safety Tips & Side Effects
What To Expect Before Your CT Scan
- Medications: It is important for you to keep to your regular medication schedule. Please take all the medications that have been prescribed to you by your doctor. Just let our staff know what medications you have taken prior to your test. Please bring your list of medications with you to your appointment.
- Food and drink: You should not eat solid foods for two hours prior to your test if you are having a CT scan of your abdomen and/or pelvis, or if you are having any CT for which IV contrast will be injected. You may, however, drink plenty of fluids, such as water, broth, clear soups, juice, or black decaffeinated coffee or tea. We encourage you to drink plenty of fluids before your arrival to our department.
- When to arrive: If you are having a CT scan of your abdomen or pelvis, you need to arrive two hours before your scheduled appointment. This is to allow time for you to drink barium sulfate before your exam and to ensure that the barium fluid completely coats your gastrointestinal tract. The barium helps to highlight body areas for the CT scan. If you are having a scan of a body part other than the abdomen you should arrive 30 minutes before your appointed time.
- Kidney function labwork before exam: Many CT scans require injection of intravenous contrast solution (dye). Many patients, including all patients over age 60 and certain patients with other medical conditions that can predispose to kidney disease, will need to have current kidney function labs within 30 days of imaging. If lab results are not available, patients may need to have blood drawn in the radiology department prior to imaging. This is for your safety, as patients with significantly diminished kidney function are at increased risk for kidney damage from IV contrast.
- What to wear: You should dress in comfortable clothing. If you are wearing jewelry or anything else that might interfere with your scan, we will ask you to remove it.
- Diabetic conditions: If you are an insulin-dependent diabetic, please continue to take your insulin as prescribed, but be prepared to drink fruit juice as needed while you fast for two hours in preparation for your CT scan.
- Intravenous preparation: Many patients receive a contrast agent intravenously (IV) during their CT test. If your doctor or the radiologist has determined that this procedure will enhance your CT scan results, the technologist will place an IV in your arm or hand prior to going into the test.
- Hydration Protocol: Some patients with abnormal kidney lab values will require intravenous hydration to reduce the chance that IV contrast will cause kidney impairment, to which they are more susceptible. This requires a four hour stay in the radiology department and can only be accommodated by advance appointment during regular business hours. Sodium bicarbonate solution is used for gentle hydration before and after imaging.
Why is barium used during some X-ray tests?
The gut (gastrointestinal tract) does not show up very well on ordinary X-ray pictures. However, if you drink a white liquid that contains a chemical called barium sulfate, the outline of the upper parts of the gut (oesophagus, stomach and small intestines) shows up clearly on X-ray pictures. This is because X-rays do not pass through barium.
Types of barium test
Depending on what part of your gut is being looked at, you may have one or more of the tests listed below. In each test, the barium coats the lining of the gut being tested. Therefore, abnormalities in the lining or structure of the gut can be seen on the X-ray pictures.
In each of the following tests, several X-ray pictures are taken using low-dose X-rays. The total amount of radiation for each test is quite small and thought to be safe. The X-ray machine is usually linked to a TV monitor. Still pictures, or a video recording of X-ray pictures taken in quick succession, can be taken if necessary.
In this test you drink some barium liquid. The barium liquid is often fruit-flavoured so it is pleasant to drink. You stand in front of an X-ray machine whilst X-ray pictures are taken as you swallow. This test aims to look for problems in the gullet. These include a narrowing (stricture), hiatus hernias, tumours, reflux from the stomach, disorders of swallowing, etc. You will usually be asked not to eat or drink for a few hours before this test. A barium swallow test takes about 10 minutes.
Barium swallow X-ray
By Netha Hussain (Own work) via Wikimedia Commons
This is similar to a barium swallow. However, it aims to look for problems in the stomach and the first part of the gut (small intestine), known as the duodenum. These problems may include ulcers, small fleshy lumps (polyps), tumours, etc.
You drink some barium liquid but you then lie on a couch whilst X-ray pictures are taken over your tummy. It may take a little longer to do than a barium swallow.
So that the barium coats all around the lining of the stomach, the doctor doing the test (radiologist) may do one or more of the following:
- Ask you to swallow some bicarbonate powder and citric acid before swallowing the barium. These ‘fizz up’ when they mix in the stomach and make some gas. (You may have the urge to burp.) The gas expands the stomach and duodenum and also pushes the barium to coat the lining of the stomach and duodenum. This makes the X-ray pictures clearer. It is the shape and contours of the lining of the stomach and duodenum which need to be seen most clearly on the pictures.
- Ask you to turn over on to your stomach on the couch. Various X-ray pictures may be taken whilst you are in different positions.
- You may be given an injection of a drug that makes the muscles in the stomach and gut relax.
You will usually be asked not to eat anything for several hours before this test. (Food particles in the gut can make it difficult to interpret the X-rays.) However, you may be allowed sips of water up to two hours before the test.
Barium meal stomach X-ray
By Lucien Monfils (Own work) via Wikimedia Commons
Barium follow through
This test is similar to a barium meal but aims to look for problems in the small intestine. Therefore, you drink the barium liquid but then need to wait 10-15 minutes before any X-rays are taken. This allows time for the barium to reach the small intestine. You may then have an X-ray every 30 minutes or so until the barium is seen to have gone through all the small intestine and reached the large intestine (colon). This test will last longer than the previous ones. The overall time taken will depend on how quickly your gut moves things along.
Barium follow through showing small bowel
By Glitzy queen00 at English Wikipedia, via Wikimedia Commons
Small intestine enema
This test is similar to a barium follow through. However, instead of drinking the barium liquid, a thin tube is passed down your gullet, through the stomach and into the first part of the small intestine. Barium liquid is then poured down the tube. This test is not commonly done but can give some different information about the small intestine to the tests above.
This is a test to take X-ray pictures of the colon. See the separate leaflet called Barium Enema for more details.
What preparation do I need to do?
This will depend on which of the tests listed above you need to have. Your local hospital will give you advice on what to do before the procedure.
After you have had a barium X-ray test
You should be able to go home as soon as the test is finished.
You can eat normally straight after any barium test.
The barium does not get absorbed into the body. Therefore, it is rare for a barium test to cause any other complications or side-effects.
Are there any side-effects of a barium x-ray?
Some people feel a little sickly for a few hours afterwards.
The barium may make you constipated. Therefore, to help prevent constipation:
- Have lots to drink for a day or so to flush the barium out of your gut.
- Eat plenty of fruit for a day or so.
- See your doctor if you haven’t passed any poo after three or four days.
The barium will make your poo white or pale until it has all come out of your gut (after a day or so).
If you had an injection to relax the muscles in your stomach, it may cause some blurring of your vision for an hour or so. If this happens it is best not to drive.
Some other points about barium X-ray tests
Tell your doctor if you have insulin-dependent diabetes, so that you can arrange for the best time for you to stop eating and for the test to be done.
Pregnant women, if possible, should not have an X-ray test, as there is a small risk that X-rays may harm the unborn child. This is why women are asked before having an X-ray whether they are, or might be, pregnant.
Barium Sulfate oral suspension
What is this medicine?
BARIUM SULFATE (BA ree um SUL fate) is a contrast agent that is used to help x-ray diagnosis of problems in areas of the upper GI tract, like the esophagus, the stomach, and/or the small intestine.
This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.
What should I tell my health care provider before I take this medicine?
They need to know if you have any of these conditions:
eczema or a history of significant allergies
intestinal blockage or perforation
intestinal or stomach cancer
recent rectal biopsy
an unusual or allergic reaction to Barium Sulfate, other medicines, foods, dyes, or preservatives
pregnant or trying to get pregnant
How should I use this medicine?
Take this medicine by mouth. Your health care professional will tell you how to prepare for your test. If you have not received instructions or if you do not understand them, check with your health care professional before the test.
Talk to your pediatrician regarding the use of this medicine in children. While this medicine may be prescribed for children for selected conditions, precautions do apply.
Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
NOTE: This medicine is only for you. Do not share this medicine with others.
What if I miss a dose?
If you cannot follow the steps to prepare for your test, tell your health care professional. The test may need to be re-scheduled.
What may interact with this medicine?
Interactions are not expected. You may or may not be able to take your regular medications during the time of preparation for your procedure. Ask your doctor or health care professional for advice.
This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.
What should I watch for while using this medicine?
Follow all instructions from your health care professional to properly prepare for your test. Serious side effects of the test are rare, but report an unexplained fever, blood in the stool, or significant abdominal pain promptly.
After the test, drink plenty of water to help avoid constipation and to help flush the barium out. You may have light or white stools for a few days after the test. Your stools will go back to normal color within a few days.
What side effects may I notice from receiving this medicine?
Side effects that you should report to your doctor or health care professional as soon as possible:
allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
nausea or vomiting
stomach or lower abdominal pain
Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Where should I keep my medicine?
Keep out of reach of children.
Store at room temperature between 15 and 30 degrees C (59 and degrees F). Keep container tightly closed. Do not freeze. Throw away any unused medicine after the expiration date.
NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.
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Barium swallow and barium meal
- What is a barium swallow/meal?
- What does the procedure involve?
- How do I prepare for a barium swallow/meal?
- What will the results show?
What is a barium swallow/meal?
Both barium swallows and barium meals are investigations of the upper gastrointestinal tract which use a contrast substance called barium which shows up on X-ray. Barium is a chalky mixture which needs to be swallowed in order to slowly pass through the bowel and create a lining on the inner wall of the gastrointestinal tract. Without the barium the lining is normally difficult to visualise. A series of X-rays are taken to allow the doctor to identify areas of abnormality such as tumours, inflammation or ulcers.
A barium swallow examines the oesophagus (the first part of the gastrointestinal tract where food passes when it is swallowed) to identify any reflux (movement of substances the wrong direction that can cause indigestion) or abnormal motility. Barium meal on the other hand examines further down to the stomach and duodenum (first section of the small intestine) to investigate causes of bleeding, vomiting or severe upper abdominal pain. Both procedures are considered to be relatively safe but sometimes other investigations such as endoscopy may be better considered a better investigation as they provide more detail.
What does the procedure involve?
Barium swallows (oesophagus) and barium meals (stomach and duodenum) are techniques used to visualise the interior of the upper gastrointestinal tract using the radio-opaque substance barium. It is normally performed in hospital radiology departments. For the procedure you will be required to wear a hospital gown and drink approximately one cup of a barium solution which comes as a flavoured milky drink. This coats the inside lining of the oesophagus, stomach and small intestine. The doctor will then take lots of X-ray images of you standing and then lying down in many different positions. This ensures all angles are examined and that the contrast medium lines all areas of the gastrointestinal tract wall. The X-rays will be both still images (which you may be required to hold your breath for) and short video images seen up on a television monitor. In some cases a muscle relaxant will be injected into the abdomen to prevent the bowel contracting and inhibiting the images.
For barium meal studies the barium is combined with a fizzy mixture that produces gas in the bowel. This is called a double contrast study. The gas expands the stomach and intestines and helps push the barium against the wall. This allows more detail to be visualised. The procedure will normally take around half an hour but if the radiologist considers the images obtained not to be good enough quality, more pictures will be taken. In some cases the barium may be followed through the entire small intestine for the next hour or so depending on the speed of your bowel movements. This is called a small bowel follow through but it is better to do this separately as it uses slightly different methods.
The procedure should not be painful but some patients may find it uncomfortable due to the gas causing an urge to burp. After the procedure you can normally go home promptly and resume normal activities and diet. You should not drive immediately after the procedure because some of the drugs can affect vision. You may feel a bit ill after the procedure and can be quite constipated for several days. You should drink lots of fluid and eat lots of fruit to minimise the constipation. Your bowel motions will also be pale due to the contrast passing through the body. After the procedure the radiologist will carefully examine all the images and write a detailed report. You will then have a follow up appointment with your doctor to discuss the results and the need for further investigations or treatment.
How do I prepare for a barium swallow/meal?
Prior to the procedure you doctor will explain the procedure, the reason for the investigation and possible risks before getting you to sign an informed consent form. The procedure is usually performed at a hospital via an outpatient appointment. You will normally have to fast (not eat or drink anything except water) for eight hours before the procedure to ensure the upper gastrointestinal tract is empty so food does not obstruct the view.
Smoking is also not recommended for several hours before the procedure as this can cause secretions to build up which again can obstruct the image. If you have diabetes special arrangements may be required regarding fasting so you should discuss this with your doctor.
What the results will show
Your doctor may order a barium investigation for the following symptoms:
- Difficulty swallowing.
- Severe upper abdominal or chest pain.
- Unexplained vomiting.
- Blood in your bowel motions.
Barium swallow and meal both show the lining of the upper gastrointestinal tract which allows your doctor to identify abnormal areas. This may include sites of blockage, narrowing, ulceration, abnormal growths, filling defects or damage to the digestive tract lining. The doctor can use the results to determine the most likely cause of your symptoms to allow follow up investigations and treatments. In some cases no abnormalities may be identified.
You will be required to make a follow up appointment with your doctor to discuss the results of the test and the next course of action.
Barium swallow and barium meal are considered to be safe procedures but there is a small risk of complications. These include:
- Potential spillage of barium- Barium should not be used in patients whom the doctor suspects there may be a significant hole in the gastrointestinal lining. In most cases barium will not be used until this condition has been excluded by other investigations. Normally however, the contrast is not absorbed into the body so should not cause side-effects.
- Bowel obstruction- Barium should not be used in patients with a suspected bowel obstruction as the barium can solidify and worsen the obstruction.
- Radiation exposure– A small radiation dose is received during the procedure but the increased risk of cancer or mutations is extremely low. Pregnant women should not have this procedure performed due to the possible risks of radiation to the unborn fetus.
- Allergic reactions to the contrast.
- Suction of the contrast into the airways instead of the gastrointestinal tract.
- Blurred vision- The muscle relaxant injection can impair near vision for about half an hour so you should make sure you do not drive for this period.
- Constipation– Patients can experience constipation for a few days after the examination so you should drink lots of fluid and eat plenty of fruit to try and prevent it during this period. Stools are also likely to be pale due to the contrast.
- Further investigations- Since these procedures rely on X-ray images a lot of detail can be missed, particularly if the abnormalities are mild or lesions are flat. You may require an endoscopic procedure (where a slender tube with a camera is inserted down the throat) to directly visualise the walls or to take tissue samples (biopsy).
Your doctor will explain these risks in further detail and offer you the opportunity to ask questions about any particular concerns you may have.
- Burkitt, Q. Essential Surgery. 3rd Edition.Churchill Livingstone. 2002.
- Kumar, C. Clinical Medicine. 5th Edition. Saunders. 2002.
- Costas H & Kefalas, MD. Commonly performed radiographic tests in gastroenterology . The American College of Gastroenterology. Available from: http://www.gi.org/patients/gihealth/radiographic.asp
- Halliday KE, Patel SR & Baker WN. Case report: colonic obstruction following small bowel barium study. The British Journal of Radiology, Vol 66, Issue 788 725-726.
What to Expect from Your Barium Swallow Test
Your doctor may give you some dietary guidelines before your barium swallow test, and it’s important that you follow them closely if this is the case. In most cases, you aren’t supposed to eat or drink anything for six hours prior to the test, though you can take small sips of water up until two hours beforehand. If the test is combined with others, or if you have any medical conditions, your doctor may give you slightly different directions. Notify your doctor in advance if you have or have had any of these conditions:
- A perforation of the esophagus or bowel
- Bowel obstruction
- Trouble swallowing
- Severe constipation
During the Test
The steps for a standard barium swallow test will go as follows:
- •You’ll go to a local radiology facility for your test, which will be performed by a radiology technician
- •You’ll be asked to remove your clothing and any jewelry, and will change into a medical gown
- •You’ll be positioned on an X-ray table, and potentially asked to move your body around as standard X-rays are taken of your heart, lungs and abdomen
- •After this first round of X-rays, you’ll be given a barium drink to swallow
- •Either X-rays or fluoroscopy will be done to watch how the barium moves through your pharynx and you may be asked to hold your breath at times to avoid disrupting the images
- •From here, you’ll be given a thinner barium drink to swallow, and another set of X-rays or fluoroscopy will be done to watch how it moves down the esophagus
When all X-rays are complete, you’ll be finished. The test will take about 30 minutes, and there will be no restrictions to your diet or daily activities after the test unless your doctor specifies otherwise. You’ll hear from your doctor’s office within a few days to go over your test and schedule any necessary follow-up appointments.
Possible Side Effects
A barium swallow test does have some potential side effects, including constipation or fecal impaction. Drink lots of fluids and eat high-fiber foods to move the barium through your digestive tract, as these complications most often arise due to barium that remains in your body.
You may notice bowel movements that are lighter in color – once all the barium is removed from your body, this should stop. If you have trouble with bowel movements, pain or bloating in the abdomen, or stools that are smaller in diameter than usual, contact your doctor right away.
In addition, barium swallows do involve exposure to radiation from the X-ray. The risk of complications here can rise as your exposure over time does, and if you’re worried about this, you should review with your doctor all your past radiation procedures. Pregnant women should avoid barium swallow procedures, as these can cause birth defects.
Your doctor can offer additional information on a barium swallow test and can recommend it for you if it’s necessary.
Upper GI Series Preparation, Safety Tips & Side Effects
An Upper Gastrointestinal (GI) is an x-ray examination of the pharynx, esophagus, stomach and first part of the small intestine (also known as the duodenum) that uses a special form of x-ray called fluoroscopy and a contrast material called barium.
Patient Safety Tips Prior to a Diagnostic Exam in Radiology
- Please let us know if you have any allergies or adverse reactions to medications.
- If you are pregnant or may be pregnant, please tell your doctor or technologist.
- Please leave your valuables at home or in your room in the hospital.
- Please let us now if you need interpreting services, this can be arranged for you.
Preparation for the Exam
- On the day preceding the exam, do not eat any solid foods.
- Remove all metallic items from area to be examined.
- Please arrive 15 minutes before the scheduled exam time.
During the Exam
- The technologist will verify your identification and exam requested.
- You will have the opportunity to ask the technologists questions.
- There will be an opportunity for you to talk with the radiologist about the plan for the procedure and give your consent.
- You may be asked to drink a carbonated drink, made of baking-soda crystals to expand your stomach.
- You will be asked to drink a thick, chalky barium contrast agent.
- The duration of the exam will vary, but the average is about 30 minutes.
- The technologist will position you on the exam table, and give you instructions.
After the Exam
- The barium will make your stools white for a few days.
- If you are going home, you may resume normal activities.
- Drink plenty of fluids in the days following the exam.
- If you experience constipation after the exam, tell your doctor