Barium Swallow: the thoracic esophagus (cont.)

The Barium Tablet

The barium tablet (BAR-TEST®, Glenwood, Inc., Tenafly, NJ) is used to detect subtle esophageal strictures. In addition, the tablet of known diameter (1/2 inch or 12.7 mm) provides a gauge for determining the true size of the residual lumen at the site of an esophageal ring or stricture. A tablet diameter of 1/2 inch was selected for two reasons: 1) Schatzki demonstrated that patients with esophageal rings of less than 13 mm diameter invariably had dysphagia, and 2) it corresponds to the diameter of the standard adult endoscope (13 mm).

Indications for use of the barium tablet:
  1. To confirm or exclude a clinically significant stricture in any patient with a history of solid food dysphagia but no obvious cause 

  2. To permit calculation of the true diameter of a constriction, since the magnification factor on the radiographs can be determined from the known size of the tablet

Method:

  1. The patient swallows the barium tablet with a small amount of water in the upright position. Transit of tablet is followed fluoroscopically.   

  2. If tablet passes through the esophagus without delay, the study is considered to be normal, and symptoms are less likely to be due to obstruction. 

  3. If the tablet holds up, the patient is requested to take one or two additional swallows of water. If tablet still does not pass, this is abnormal. Have the patient swallow "thin barium" to allow simultaneous visualization of the tablet and the stricture causing the obstruction. This should be documented with spot images. The tablet will spontaneously disintegrate within 30 minutes.
 

2002 by the Rector & Visitors of the University of Virginia