A Barium Esophagram, also known as an Esophagogram, remains a valuable test in clinical practice for the structural and functional evaluation of the esophagus.<\/p>\n
A Barium Esophagram can provide valuable information about the functional evaluation of the pharynx, mucosal abnormalities, and motility disorders of the esophagus. The barium esophagogram remains the first imaging method in the evaluation of dysphagia, gastroesophageal reflux, and other esophageal diseases beyond the scope of endoscopy.<\/p>\n
Simultaneous structural and functional evaluation of the esophagus can also be performed. Diagnostic tests for evaluating the esophagus consist of demonstrating structural disorders, identifying functional anomalies, and measuring the esophagus’s exposure to stomach acid.<\/p>\n
The first preferred radiological test for evaluating the morphology and motor functions of the esophagus is a barium esophagogram. Difficulty swallowing, burning sensation in the throat, painful swallowing, chest pain, globus sensation, and pre-and post-treatment evaluation are the main indications for a barium esophagogram.<\/p>\n
Combined fluoroscopic evaluation with barium is more effective in diagnosing these diseases. When an esophageal disease is suspected, the first test for patients should be barium imaging, which includes a full evaluation of the stomach and duodenum.<\/p>\n
Preparation is required before the procedure. The patient should not eat, drink water, or smoke for at least 8 hours before the test.<\/p>\n
The test begins by having the patient drink a barium liquid that looks like plaster on an empty stomach. The swallowing function is evaluated through images taken during swallowing. Once the barium fills the stomach, the patient is turned upside down, and as images continue to be taken, the full contours of the fundus region become visible, and it can be determined if there is leakage into the esophagus, indicating reflux.<\/p>\n
The opaque substance is ingested quickly to fill the entire esophageal lumen. Using this method, cancer, large ulcers, and webs can be identified, and the contour, motility, and expansion ability of the esophagus can be effectively evaluated.<\/p>\n
Continuous dynamic imaging is preferred for assessing pharyngeal and esophageal motility. In a normal adult, bolus passage through the 20-24 cm long esophagus is completed within 6-8 seconds. Retention and delayed emptying of barium in patients with esophageal motility disorders are significant findings.<\/p>\n
After reaching the stomach, the folds of the stomach and ulcers in the stomach wall appear as outward bulging filling defects. Filling defects that protrude inward indicate the presence of a mass, suggesting stomach cancer.<\/p>\n
Small protruding filling defects on top of these inward defects indicate the presence of an ulcer that has developed on a tumor in the stomach. When there are protruding outward filling defects from the contours of the stomach wall, benign ulcers caused by excess stomach acid are considered, while the inward defects with protruding filling defects suggest gastric cancer ulcers.<\/p>\n
If the barium passes through the stomach outlet without obstruction, filling defects or persistent filling areas in the bulb and duodenum may indicate ulcers. Narrowing caused by ulcers in the bulb and duodenum is also easily visible on this X-ray.<\/p>\n
Webs are thin mucosal folds seen on the anterior wall of the hypopharynx and proximal cervical esophagus. On a barium esophagram, they appear as shelf-like filling defects (1-2 mm thick) on the anterior wall of the cervical esophagus [Figure 1A]. A jet phenomenon may be seen in cases of partial obstruction [Figure 1B]. A prominent cricopharyngeal muscle, sometimes seen as a protrusion from the posterior pharyngeal wall, can be mistaken for an esophageal web [Figure 1C].<\/p>\n
(A) A pharyngoesophageal junction web on a barium esophagram appears as a shelf-like filling defect on the anterior wall of the hypopharynx. (B) The jet phenomenon associated with a cervical web, often seen in cases of partial obstruction. (C) A prominent cricopharyngeus muscle may mimic a web but is seen on the posterior wall.<\/p>\n
Lower esophageal rings, mostly asymptomatic, are a common finding on barium esophagrams. A Schatzki ring is a symptomatic esophageal ring that presents as dysphagia. It is thought to develop due to scarring in cases of reflux esophagitis.<\/p>\n
On a barium esophagram, the ring appears as a smooth concentric segment of luminal narrowing (2-3 mm thick), typically located above a hiatal hernia [Figure 2]. Rings larger than 20 mm in diameter are asymptomatic, while rings smaller than 13 mm in diameter always cause dysphagia.<\/p>\n
Figure 2: Schatzki ring<\/p>\n
Esophageal diverticula are categorized as pulsion diverticula, traction diverticula, and intramural pseudodiverticula.<\/p>\n
Pulsion diverticula occur in the lower esophagus and are usually associated with esophageal motility disorders. These are false diverticula lacking the muscular layer. On a barium esophagram, they appear as wide-based contrast-filled sacs showing barium retention after the esophagus empties [Figures 3A, 3B].<\/p>\n
Traction diverticula are true diverticula (as they contain all layers of the esophagus) seen in the middle esophagus. They are usually caused by scarring in perihilar lymph nodes from tuberculosis or histoplasmosis. On a barium esophagram, traction diverticula appear as triangular or tent-like projections and collapse when the esophagus empties [Figure 3C].<\/p>\n
Esophageal intramural pseudodiverticulosis can be associated with esophageal strictures or occur alone. When present alone, it is asymptomatic. Intramural pseudodiverticulosis is the dilation of the ducts of the deep mucosal glands of the esophagus. On a barium esophagram, it appears as multiple contrast-filled sacs parallel to the long axis of the esophagus.<\/p>\n
Figure 3 (A) Pulsion diverticulum. Multiple non-peristaltic contractions associated with motility dysfunction are also visible. (B) Large epiphrenic diverticulum. (C) Traction diverticulum arising from the anterior wall of the mid-esophagus. Note the triangular shape of the traction diverticulum.<\/p>\n
Motility disorders can be primary or secondary. In primary motility disorders, the esophagus is the main affected organ. Secondary motility disorders occur as manifestations of various systemic diseases or secondary to esophageal damage. Primary motility disorders include achalasia and its variants, diffuse esophageal spasm (DES), nutcracker esophagus, nonspecific esophageal motility disorder, and hypertensive lower esophageal sphincter (LES).<\/p>\n
Primary achalasia is an idiopathic condition caused by a defect in the myenteric plexus. On manometry, it is characterized by incomplete relaxation of the LES, increased resting pressure of the LES, and absence of primary peristalsis. On a barium esophagram, the esophagus becomes dilated due to the absence of primary peristalsis and shows a beak-like narrowing near the gastroesophageal junction [Figure 4A].<\/p>\n
Sometimes, the esophagus is greatly dilated and tortuous, referred to as a “sigmoid esophagus” [Figure 4B]. Primary achalasia must be distinguished from secondary achalasia, which can occur due to tumors at the gastroesophageal junction or cardia that destroy the nerves and interfere with normal peristaltic activity.<\/p>\n
In secondary achalasia, mucosal irregularities, nodularity, and ulceration are present, and the narrowed segment is longer (> 3.5 cm) than in primary achalasia [Figure 4C]. Clinically, patients with secondary achalasia are older (typically over 60 years old) and present with newly onset dysphagia (less than 6 months), often with weight loss, as opposed to the long-standing dysphagia in younger patients with primary achalasia.<\/p>\n
Two variants of achalasia with atypical manometric findings have been described: vigorous achalasia and early achalasia. In vigorous achalasia, there are multiple recurrent contractions of the LES, and the patient may complain of chest pain. In early achalasia, there is normal relaxation of the LES without primary peristalsis. In both variants, patients tend to present at a younger age with less esophageal dilation on barium studies.<\/p>\n
Figure 4 (A-C) Primary achalasia: an oblique image showing a dilated esophagus with a beak-like narrowing at the gastroesophageal junction (arrow). Fluoroscopy revealed the absence of primary peristalsis in the esophagus. (B) Dilated and tortuous esophagus in a case of primary achalasia. (C) Secondary achalasia: mild dilation of the esophagus with narrowing involving the lower thoracic esophagus and gastroesophageal junction, showing mucosal irregularity on an oblique image (arrow). Note the longer narrowed segment and less esophageal dilation compared to (A).<\/p>\n
For information about the 2026 prices of barium esophagrams, please contact us immediately.<\/p>\n
How Much Does It Cost?
\nDr. Abdullah Cevahir
\nRadiologist
\nHekimo\u011flu Imaging and Diagnosis Center<\/p>\n","protected":false},"excerpt":{"rendered":"
What Is A Barium Esophagram? A Barium Esophagram, also known as an Esophagogram, remains a valuable test in clinical practice for the structural and functional evaluation of the esophagus. A Barium Esophagram can provide valuable information about the functional evaluation of the pharynx, mucosal abnormalities, and motility disorders of the esophagus. The barium esophagogram remains […]<\/p>\n","protected":false},"author":1,"featured_media":1027,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[],"class_list":["post-205","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-digital-x-ray"],"_links":{"self":[{"href":"https:\/\/www.hekimoglugoruntuleme.com\/en\/wp-json\/wp\/v2\/posts\/205","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hekimoglugoruntuleme.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hekimoglugoruntuleme.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hekimoglugoruntuleme.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hekimoglugoruntuleme.com\/en\/wp-json\/wp\/v2\/comments?post=205"}],"version-history":[{"count":5,"href":"https:\/\/www.hekimoglugoruntuleme.com\/en\/wp-json\/wp\/v2\/posts\/205\/revisions"}],"predecessor-version":[{"id":4005,"href":"https:\/\/www.hekimoglugoruntuleme.com\/en\/wp-json\/wp\/v2\/posts\/205\/revisions\/4005"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.hekimoglugoruntuleme.com\/en\/wp-json\/wp\/v2\/media\/1027"}],"wp:attachment":[{"href":"https:\/\/www.hekimoglugoruntuleme.com\/en\/wp-json\/wp\/v2\/media?parent=205"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hekimoglugoruntuleme.com\/en\/wp-json\/wp\/v2\/categories?post=205"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hekimoglugoruntuleme.com\/en\/wp-json\/wp\/v2\/tags?post=205"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}