We performed a retrospective review of barium swallow studies conducted in our clinic over the past two years. We focused on both esophageal and pharyngeal evaluation, assessing motility disorders and distinguishing esophageal dysphagia from oropharyngeal dysphagia. The findings were analyzed against results from other diagnostic tools, including CT and endoscopy.

We sought to answer the question: Why does the barium swallow still matter? It remains relevant due to its unique ability to assess both structure and function dynamically. It plays a pivotal role in diagnosing conditions where newer techniques may lack precision or availability, such as postoperative complications (e.g., fistulas).

The protocol in our clinic includes an initial discussion with the patient, as cooperation is essential for an accurate study. The swallow study is typically performed using barium; however, iodinated contrast may be used when a fistula or postoperative complication is suspected, provided the patient has no known allergy. During the procedure, the patient is instructed to swallow the contrast material multiple times as necessary. Meanwhile, the resident doctor conducts fluoroscopy, carefully assessing the region of interest based on the suspected diagnosis. Various positions, including AP, lateral, and oblique views, are utilized to ensure thorough evaluation. The study concludes with the patient placed in the Trendelenburg position to evaluate esophagogastric reflux.

The barium swallow study plays a pivotal role in the diagnosis and evaluation of esophageal and pharyngeal disorders. Its primary functions include: evaluation of swallowing dynamics and bolus transit, identification of anatomical abnormalities, including strictures (benign and malignant), esophageal diverticula, and hiatal hernias. The clinician observes the coordination between phases of swallowing, bolus propulsion, and esophageal clearance.

The doctors in our clinic who most frequently request this procedure are from the fields of gastroenterology, surgery, otolaryngology, and rheumatology. They utilize the barium swallow study to:

• Determine esophageal patency, particularly after a failed endoscopy.
• Identify the presence of a pre- or postoperative fistula.
• Evaluate whether patients presenting with dysphagia have normal swallowing function.
• Assess whether a specific rheumatic disease is affecting the esophagus.

This highlights the procedure’s versatility and its critical role in multidisciplinary care.