Barium esophagram

This test is done in radiology (x-ray department) and involves drinking a chalky substance called barium that can be seen on x-ray. The radiologist (physician) has the patient drink the barium and observes by x-ray how the barium moves through the esophagus and into the stomach. If GE reflux (backwashing of stomach contents into the esophagus) occurs during the test, it can be seen as barium backing up from the stomach into the esophagus. Esophageal narrowing (strictures) can also be seen as well as some ulcers and tumors. The problem with this test is that it can miss small abnormalities in the esophagus such as small erosions or ulcers. Another problem is that GE reflux may occur in normal individuals but not necessarily in  GERD patients at the time of the barium test. Although there can be some findings on barium esophagram to suggest the presence of Barrett's esophagus, the diagnosis of Barrett's esophagus cannot be confirmed with this test. The advantage of this test is that it can be ordered by a primary care physician and if erosions, strictures, ulcers or tumors are seen, these are highly specific for esophageal disease.