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:
To confirm or exclude a clinically significant stricture in any patient
with a history of solid food dysphagia but no obvious cause
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
The patient swallows the barium tablet with a small amount of water in
the upright position. Transit of tablet is followed fluoroscopically.
If tablet passes through the esophagus without delay, the study is
considered to be normal, and symptoms are less likely to be due to
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.