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Question:
“I am confused about when is it appropriate to order an Esophagram instead of a Barium Swallow or an Upper GI exam?”

Dr. Yoler Responds:
To start, an esophagram and a barium swallow are two names for the same examination. With that established let’s look closer at this question. It has been a practice for some physicians to order both an esophagram and an Upper Gastrointestinal Study (UGI) on patients, particularly those who have symptoms suggesting gastroesophageal reflux. This is not necessary.

An UGI includes everything from the mouth all the way to the small bowel just beyond the Ligament of Treitz. Therefore, when we do an UGI examination, we thoroughly examine the esophagus, we look for a hiatal hernia and esophageal reflux. Any time we would see anything in the esophagus that would require documentation, spot filming and/or overhead filming would be obtained, just as it would if we saw something in the stomach or duodenal bulb.

So, in most instances, the combination of ordering an esophagram with an upper GI is redundant because an esophagram is part of an upper GI. It is not redundant to order an esophagram (aka Barium Swallow) by itself if, for instance, dysphagia is the only symptom and there are no other upper gastrointestinal complaints. (The insurance companies will pay for an esophagram done by itself.) I would urge you to keep this in mind when ordering barium studies of the upper gastrointestinal tract. If you order an esophagram/upper GI combination your patient may have to pay more out of pocket, as the insurance companies normally would pay for only one of the procedures—and that is the esophagram, since it is the lowest reimbursement.

Esophagram (Barium Swallow)
Indication: The esophagram test is ordered to assess symptoms of painful or difficult swallowing, bloodstained vomit, abdominal pain and weight loss. Our radiologist is able to detect narrowing or irritation of the esophagus, blockages, hiatal hernia, abnormally enlarged veins that may cause bleeding in the esophagus, ulcers, polyps or tumor.

Description: The esophagram or barium swallow is a test whereby a patient is instructed to drink a barium sulfate compound that enables the radiologist to study the function and appearance of the esophagus and assess the swallowing process.

Procedure: For this test, the patient is given a cup of barium sulfate to drink while the radiologist watches and evaluates the swallowing process with fluoroscopy (an x‐ray unit combined with a TV monitor). As the barium coats the lining of the esophagus x‐rays are taken to track the pathway to the stomach.The patient is placed in various positions throughout the exam so that structures are optimally demonstrated on the x‐rays. The approximate time for the examination is 30 minutes.

Upper Gastrointestinal (GI) Series
Indication: The upper GI series is indicated for assessing problems such as abdominal swelling, bloating, pain, nausea and vomiting. It may be used to detect the cause of painful or difficult swallowing. The radiologist may also find evidence of ulcers, scar tissue, abnormal growths, hiatal hernia or blockage of the normal food path through the digestive tract.

Description: The upper GI series is a test to diagnose problems in the esophagus, stomach and duodenum. A barium drink is given to the patient to swallow to coat the lining of the esophagus, stomach and duodenum allowing them to show up clearly on the x-ray images. The upper GI series can demonstrate a blockage, abnormal growth, ulcer or identify a problem with organ function.

Procedure: The technologist may take an initial film of the abdomen (a scout film) to make sure that the GI tract is properly prepped for the exam. The procedure is performed on a table with tilting capabilities so the radiologist is able move the patient from a standing to a reclined position. The patient may be given a small cup of effervescent crystals to swallow that allow gas to be created in the stomach for better imaging. The patient is then given a cup of barium and instructed to drink.

The radiologist watches the travel of the barium with fluoroscopy as it moves down the throat, into the stomach and finally into the small bowel. X-rays are taken with the patient in various positions that best demonstrate the areas of interest. The approximate time for the exam is 30 to 45 minutes.

If you have additional questions on when to order an esophagram versus a UGI series, please call a WIS radiologist at 425-688-0100, Ext 1 or call Gary Beneze, our Clinical Marketing Director at 425-462-4742.