By Dr Ananya Mandal, MD
Principles of Barium meal
A barium meal is a diagnostic test used to detect abnormalities of the esophagus, stomach and small bowel using X-ray imaging. X-rays can only highlight bone and other radio-opaque tissues and would not usually enable visualization of soft tissue. However, infusion of the contrast medium barium sulfate, a radioopaque salt, coats the lining of the digestive tract, allowing accurate X-ray imaging of this part of the abdomen.
The images produced are fluoroscopic and can be viewed in real-time as well as on plates.
Who can perform a Barium meal test?
A barium meal can be performed by a radiologist (or radiographer) who has specialist skills in imaging studies and works as a healthcare professional to diagnose and treat illness.
Before a barium meal test is performed, the duodenum needs to be empty to allow clear visualization of structures. A patient may be given a laxative the night before the procedure to ensure the small bowel is empty at the time of the test, which is usually performed on an empty stomach.
The patient is first asked to change into a hospital gown and remove all jewellery, dentures, glasses, metal objects and clothing as these items can interfere with imaging.
First, some fizzy granules, called carbex granules are given to the patient to create gas and expand the stomach for clearer viewing. Next, the barium contrast liquid is given to the patient to drink.
Some initial images are taken to check that the barium has passed through the esophagus, and into the stomach and small bowel. The radiographer then takes a series of X-ray images over time as the barium contrast moves through the digestive system. This may mean images are taken over anywhere between 1 and 4 hours. Once the barium contrast has passed through to the large bowel or the colon, more pictures are taken. The whole test may take around 5 hours.
Why is this procedure performed?
Barium meal examination is usually performed to help diagnose various diseases or disorders of the digestive system. These include constrictions, hernias, obstructions or masses in the esophagus or stomach, and inflammatory or other diseases of the intestines.
Exposure to X-rays carries a similar risk as exposure to ionizing radiation. However, the amount of radiation a person is exposed to during an X-ray is is very low and risks are minimal. There are no risks associated with the barium liquid because it is not absorbed by the body.
Some patients, however, are at risk of breathing in or aspirating the barium. X-rays are also harmful to unborn babies and should be avoided by women who are or may be pregnant. Women are asked details of the dates of their last menstruation to ensure the test is performed while the risk of pregnancy is at its lowest.
After the test
Some patients may feel abdominal bloating after a barium meal test and the test may also lead to constipation. Patients are therefore advised to drink plenty of fluid and eat plenty of fruit and vegetables. Mild laxatives may also help. Stools may be pale or whitish for a few days after the test.
Reviewed by Sally Robertson, BSc