• NPO for 6 hours before the examination
• The patient is asked to drink barium.
• The x-ray table is rotated in various positions to obtain adequate views
• It usually takes 10-20 minutes

Discuss the indications for barium swallow?
The primary indication is dysphagia. However an endoscopy is the preferred test
Discuss the barium swallow for achalasia?
Barium Swallow in achalasia shows:

• Dilated oesophagus that terminates in a beak-like narrowing caused by the persistently contracted LOS
• The diagnostic accuracy of barium swallow for achalasia is approximately 95 percent

Discuss the role of barium swallow as the first investigation in the diagnosis of dysphagia?
Patients with proximal dysphagia may have a pharyngeal pouch, post cricoid web etc which increase the risk of perforation on endoscopy. Barium swallow may be considered as an initial investigation for investigation of proximal dysphagia; however an endoscopy is safe as an initial test in experienced hands.
Discuss barium swallow for Schatzki ring?
Barium swallow is more sensitive than OGD. Endoscopy failed to show 1/3 of Schatzki rings demonstrated on barium swallow in one study. However, endoscopy is needed to confirm the diagnosis and exclude any other diagnosis once Schatzki ring is picked up on barium swallow.