What Is a Modified Barium Swallow?

A modified barium swallow is a medical imaging study performed while a patient eats and drinks to identify swallowing problems. Some issues may be difficult to spot under normal conditions, even with close observation. The use of x-ray fluoroscopy in a modified barium swallow can highlight the structures of the throat and how they behave while the patient eats and drinks. This test requires the presence of a speech-language pathologist along with a radiologist to control the fluoroscopy machine.

This test is also known as the “cookie swallow,” a reference to one of the foods the patient may be asked to eat during the procedure. A doctor may recommend a modified barium swallow if a patient has difficulty speaking or eating, develops a persistent cough, or has a voice that sounds wet or clogged without any obvious cause. It is possible the patient may be aspirating small amounts of food or liquid while eating, or could have a muscle dysfunction that makes it difficult to swallow. The test takes around 90 minutes.

Patients do not need to make any special preparations for a barium swallow, other than bringing some foods from home. In the case of young children, a mixture of foods the child enjoys can be helpful. At the hospital or imaging center, a technician will mix the food with barium. The speech-language pathologist may also perform an intake evaluation before the patient has eaten to discuss the situation.

The modified barium swallow itself takes around 10 to 15 minutes. The patient sits or stands in front of a fluoroscopy machine and consumes food and liquids as directed. The radiologist will make a video for the speech-language pathologist to evaluate later, and she can also watch the test in real time. She may direct the patient to try different foods and drinks. The barium is radio-opaque, and highlights structures in the mouth and upper esophagus for the benefit of the speech-language pathologist.

After the modified barium swallow, the patient can meet with the speech-language pathologist to discuss the findings and some treatment options. These may include therapy, surgery, and other steps. It is important to be aware that this test differs from a barium swallow conducted to image the esophagus all the way to the top of the stomach. That test is meant to identify reflux and other medical issues that may not be apparent on a modified swallow.