Esophagrams

An esophagram, also called a barium esophagram, is a radiographic examination of the esophagus that uses an ingested contrast agent, usually a suspension of barium sulfate, to visualize the esophageal lumen. The study is performed under fluoroscopic guidance to assess both anatomy and bolus transit.

During the examination, the patient swallows contrast in successive consistencies (thin liquid, nectar-thick, paste) while real-time X-ray records the flow of material down the esophagus and the pattern of peristalsis. The protocol may include upright and lateral views, delayed images, and cine loops. If perforation is suspected, a water-soluble contrast is used instead of barium, and double-contrast techniques may be employed to enhance mucosal detail.

Indications include dysphagia, odynophagia, suspected stricture, webs or rings, diverticula, hiatal hernia, and evaluation for suspected motility disorders such as achalasia or diffuse esophageal spasm. It can also help characterize lesions and assess postoperative anatomy or the presence of obstruction. Some protocols observe reflux during the study or use dedicated timed protocols to assess transit.

Limitations include relatively lower sensitivity for subtle mucosal disease compared with endoscopy and biopsy, radiation exposure, and the risk of aspiration or contrast reaction. Esophagrams are typically part of a multimodal evaluation and may be complemented by endoscopy, manometry, or other imaging studies as indicated.