Barium Swallow and Small Bowel Follow Through

Barium X-rays are diagnostic X-rays in which barium is used to diagnose abnormalities of the digestive tract.

Types of Barium X-Rays

If your healthcare provider has ordered a barium study, it's important to know that there are different procedures that are considered barium X-rays. These include:

  • Barium swallow (discussed below)
  • Barium small bowel follow-through (discussed below)
  • Barium enema (Lower GI series)
what to expect during a barium enema
 Illustration by Cindy Chung, Verywell

Barium Swallow

A barium swallow (also referred to as a barium esophagogram) or upper GI series may be ordered to examine the back of your throat, your esophagus, and stomach. With a barium swallow, you will be asked to drink a chalky colored liquid that contains barium. Some people have described this as drinking a flavorless strawberry shake.

Barium Swallow

Symptoms which may prompt your healthcare provider to order a barium swallow include:

  • Difficulty swallowing
  • Abdominal pain
  • Unusual bloating
  • Unexplained vomiting
  • Unintentional weight loss

The barium coats the walls of your esophagus and stomach, which is then visible on X-rays. The test is not usually sensitive enough to be used as a reliable to test for diagnosing gastroesophageal reflux disease (GERD) but may be effective in locating strictures, ulcers, hiatal hernias, erosions in the esophagus or stomach, muscle disorders such as achalasia, and other abnormalities such as tumors. A barium swallow may sometimes be used to detect esophageal cancer.

Barium Small Bowel Follow Through

Barium studies may also be used to look further down into the digestive tract. In a barium small bowel follow through you are observed as the barium you drink passes beyond your stomach into your small intestine, and eventually makes its way to your colon. In the procedure, you will often be turned side to side to best visualize the small bowel or small intestine. A barium small bowel follow-through may be done to help diagnose tumors of the small bowel, a small bowel obstruction, or inflammatory diseases of the small intestine such as Crohn's disease.

Preparation and Procedure

If your healthcare provider has ordered a barium swallow or small bowel follow through, you may be wondering what to expect. Both of these tests are usually ordered as an outpatient procedure in the hospital radiology department. Below is a general timeline of how things will go:

  1. You will most often be advised not to eat or drink anything after midnight on the night before the exam. An exception is if you take any prescription medications. Make sure to talk to your healthcare provider, but she will most likely recommend that you take any regular medications with a small sip of water on the morning of your exam. This is very important if you are taking medications such as those for heart disease.
  2. For a barium swallow, you will stand against an upright X-ray table in front of a fluoroscope, a device that will immediately show a moving picture. Then, you will drink the barium liquid and swallow baking soda crystals.
  3. The radiologist can watch the barium flow through the digestive tract. You may be asked to move into different positions while the X-rays are taken so the healthcare provider can observe the barium from different angles as it travels down the esophagus and into the stomach.
  4. Since barium may cause constipation, drink plenty of fluids and eat high-fiber foods for the next day or two until the barium passes from the body.

Cautions and Possible Side Effects

There are generally few side effects related to barium studies, with the exception of constipation. Some people are unable to tolerate the barium and vomit, but this is uncommon. Aspiration of the barium solution into the lungs is uncommon as well.

Barium studies should not be done for pregnant women, in those who may have a perforation in their digestive tract, in people who have a severe bowel obstruction, and in those who have severe swallowing difficulty (as this could increase the risk of aspiration.)


Barium studies are most often done in combination with other digestive tract tests. These may include an upper endoscopy, pH examination, and monitoring, manometry, or other imaging studies.

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By Sharon Gillson
 Sharon Gillson is a writer living with and covering GERD and other digestive issues.