esophagram
Meaning of esophagram: A moving X-ray of a swallow, showing not merely the shape of the tube but whether it actually works.
Definition of esophagram
An esophagram is an X-ray examination of the swallowing tube, carried out while a person drinks a chalky liquid containing barium sulfate. Barium blocks X-rays, so the liquid coats the inner lining and outlines the shape of the tube on the pictures. A series of images, often recorded as video, captures how the liquid moves and where it is held up.
How does barium make the tube visible?
Soft tissue barely registers on a plain X-ray, because it absorbs radiation much like the tissue around it. Barium is a dense metal, and barium sulfate absorbs X-rays strongly while passing through the gut without being taken into the body. Swallowed as a suspension, it coats the lining of the esophagus and marks out its inner surface as a white column on the image. Adding a gas producing crystal inflates the tube so the coated lining is stretched and fine detail appears, an approach called a double contrast study. The contrast material later passes in the stool.
What can it show?
| Finding | What it looks like |
|---|---|
| Narrowing | A short segment of reduced width, smooth or irregular |
| Reflux or hiatal hernia | Barium moving back up, or stomach lying above the diaphragm |
| Motility problem | Barium held up, or the tube contracting in a disordered way |
| Pouch or web | An outpouching, or a thin shelf projecting into the channel |
| Leak | Contrast escaping outside the wall |
How does it compare with endoscopy?
An endoscope shows the lining directly and in color, and allows a sample to be taken, neither of which an X-ray can do. The esophagram has different strengths. It shows the tube in motion, so it reveals how a swallow behaves rather than how the lining looks at rest. It maps the full length and shape in one picture, which is useful before an operation and after it. And it can be done when passing an instrument is not wanted. The two tests are often used together, answering different questions about one organ.
What is involved for the person having it?
Nothing is eaten beforehand, so the tube is empty. Several mouthfuls of the liquid are swallowed on request while images are taken in different positions, including lying down, and the examination is short. Where a hole or a leak is suspected, a water soluble contrast is used instead of barium. Findings such as a narrowed lower segment often prompt an endoscopy afterward, to look for Barrett esophagus or another cause.
Also known as
Used in a sentence
The esophagram showed a smooth narrowing of the lower esophagus with delayed passage of contrast.
Good to know
Barium is avoided where a perforation or leak is suspected, because barium escaping outside the gut causes a lasting inflammatory reaction, and a water soluble contrast is used in that situation instead.
Word origin
Where “esophagram” comes from
Esophagus comes from the Greek oisophagos, from oisein, meaning to carry, and phagein, meaning to eat, with -gram meaning something recorded.