Education Form on the
Modified Barium Swallow Study
By: Ronda Polansky M.S. CCC-SLP
What is a Modified Barium Swallow Study (MBSS) – a form of real-time x-ray called fluoroscopy to evaluate the ability to swallow safely and effectively. The exam is typically well tolerated, noninvasive, and can help identify the consistencies of liquid and food that a patient can most safely consume.
The patient is observed swallowing various consistencies and textures, ranging from thin liquid barium to barium-coated cookies, in order to evaluate his or her ability to swallow safely and effectively. This exam is performed with a dysphagia specialty trained speech-language pathologist present.
Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging. Fluoroscopy allows imaging of anatomical structures in real-time and allows the interpreting physician to observe structure and limited function. An MBSS may be performed as an independent test to look at the swallowing mechanism, or together with a scan of the esophagus, which evaluates the structure and function of the esophagus to the level of the stomach. The names of these two exams are similar: Modified Barium Swallow Study and a Barium Swallow Study/Upper GI, which can sometimes cause confusion when the test is ordered. Therefore, be sure to clarify with your physician which exam your doctor intended to prescribe.
What are some common uses of the procedure?
The MBSS is performed on patients of all ages with dysphagia, the technical term for difficulty swallowing. It is used primarily for evaluating the swallowing function and any evidence of aspiration, which is liquid or food going into the airway (the trachea and lungs) instead of staying in the pharynx and advancing to the esophagus.
In order to help an individual swallow more safely and efficiently, speech-language pathologists may suggest different head positions, such as tucking or tilting the chin or turning the head while swallowing. The MBSS can be used to evaluate and observe the effectiveness of these swallowing strategies. The speech-language pathologist may also suggest thickening liquids or modifying other food consistencies to help prevent penetration or aspiration of the food/liquids into the airway.
The MBSS may be performed because of a known or suspected swallowing problem or because of the presence of conditions that are strongly associated with swallowing difficulty, such as:
- coughing, throat clearing, and/or choking while eating or drinking
- pain or excessive drooling when swallowing
- wet-gurgly vocal quality when speaking
- changes in breathing when eating or drinking or after meals
- frequent respiratory infections
- known or suspected aspiration pneumonia
- soft tissue masses on the tongue, pharynx, or larynx
- muscle weakness involving the pharynx
- neurologic conditions likely to affect swallowingYou should inform your physician of any medications being taken and if there are any allergies to a specific food. Also inform your doctor about recent illnesses or other medical conditions. Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby.What does the equipment look like?For a MBSS, the individual is usually sitting upright and the image intensifier (the “x-ray eye”) is either located in front or looking in from the side of the patient.How does the procedure work?Fluoroscopy uses a continuous or pulsed x-ray beam to create a sequence of images that are projected onto a fluorescent screen, or television-like monitor. When used with a contrast material, which clearly defines the area being examined by making it appear dark (or by electronically reversing the image contrast to white), this special x-ray technique makes it possible for the physician to view joints or internal organs in motion. Still images or movies are also captured and recorded on DVD or computer. The physician and/or speech-language pathologist will take a medical history, including complaints of difficulty swallowing. A physician or technician and a speech-language pathologist will guide the individual through the swallow exam. They will be positioned upright on a chair or on a stool. If necessary, they may remain in a wheelchair. Infants and children are positioned in secure seats.The imaging portion of this procedure is usually completed within 15 minutes. You may find the taste and consistency of the barium unpleasant, but it has a fruit-based taste. The results are interpreted and reviewed by the speech-language pathologist and physician. When the examination is complete, the speech-language pathologist may meet with you to discuss the results of the exam and will also provide a report to your primary care or referring physician or staff.Follow-up examinations may be necessary, and your doctor will explain the exact reason why another exam is requested. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up examination may also be necessary so that any change in a known abnormality can be monitored over time. Follow-up examinations are sometimes the best way to see if treatment is working or if a finding is stable or changed over time.What are the benefits?
- The MBSS physician is specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will help you make choices regarding any further medical decisions or consults.
- Who interprets the results of the MBSS and how do I get them?
- After the examination, you can resume your usual diet and take orally administered medications unless told otherwise by your doctor. You may also resume your normal activities. For a day or two following your exam, your bowel movements may look white because of the barium. White bowel movements are normal. Sometimes the barium can cause temporary constipation, which is usually treated by an over-the-counter laxative. Drinking increased quantities of fluids for several days following the test can also help. If you are unable to have a bowel movement, or if your bowel habits undergo any significant changes following the exam, you should contact your physician.
- What will I experience during and after the procedure?
- The individual will be directed to eat and drink controlled amounts of foods and liquids in a variety of consistencies to which barium, a contrast material, has been added. The speech pathologist may try to help them swallow better by using different cups or utensils or changing your body position. As they eat and drink, the x-ray camera will be moved near the throat. The speech-language pathologist and physician will watch the swallow in real-time through a fluoroscope, a device that projects x-ray images in a movie-like sequence onto a monitor. The images are usually captured digitally, so they can be reviewed later.
- How is the procedure performed?
- Today, most images are digital files that are stored electronically. These stored images are easily accessible and are frequently compared and reviewed to current x-ray images for diagnosis and disease management.
- X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special detector.
- The equipment typically used for this examination consists of one or two x-ray tubes and a television-like monitor that is located in the examining area. Fluoroscopy, which converts x-rays into video images, is used to watch and guide the progress of the procedure. The video is produced by the x-ray machine.
- How should I prepare?
- The MBSS is a noninvasive procedure.
- Allergic reactions to barium are extremely rare. Barium is inert, meaning it is neither metabolized nor absorbed into the body. It enters and exits in the same form.
- The MBSS can help determine the consistencies of food that the individual can most safely eat, which can limit the risk of aspiration (liquids and/or food entering the airway and lungs).
- No radiation remains in the body after this x-ray examination.
- X-rays such as MBSS, have no side effects in the typical diagnostic range for this exam.
What are the limitations of the Modified Barium Swallow Study?
The MBSS only evaluates the area from the back of the mouth through the pharynx (throat) to the top of the chest. In some cases, the dysphagia symptoms may be due to abnormalities in the esophagus, which is lower in the chest. An esophagram, also called an upper GI or a barium swallow exam, may be recommended if the problem is thought to be lower in the esophagus and into the stomach.