What is a Modified Barium Swallow Study?

St. Joseph’s/Candler speech language pathologists explain this gold standard test to examine your swallow, make treatment recommendations

If you have a condition that is causing you to have difficulty eating or drinking, your doctor may recommend a Modified Barium Swallow Study to determine why that is happening.

A Modified Barium Swallow Study (MBSS) is a study using imaging to see a person’s swallow pattern. Speech language pathologists and radiologists work in coordination to perform the study. A MBSS helps them assess the function and coordination of the muscles and nerves used to swallow.

“We’re looking for what’s working and what’s not working,” says Anne Trees, speech language pathologist at St. Joseph’s/Candler. “We’re also using that study to assist our outpatient therapists, ourselves or the referral source in developing a treatment plan.”

A MBSS should not be confused with a regular Barium Swallow Study, which looks closer at the esophagus and other parts of the GI tract.

A MBSS is done with X-ray and fluoroscopy, which is a special kind of X-ray “movie” that shows organs in motion. In this particular study, the machine takes about 30 frames per second, which allows the speech language pathologists to watch the swallow as the liquid or food moves through the mouth and throat, Trees says.

The reason they can see the swallow is the Barium. Barium is a contrast that makes certain areas of the body show up more clearly on an X-ray. In this study, the Barium is combined with different liquid and food consistencies, Trees explains.

Typically the study starts out with thin liquids, such as water and tea combined with Barium. The patient will start with teaspoons and then cups. The study progresses with thicker liquids, such as tomato juice, and then pudding and sometimes fruits. The study finishes with a cracker or cookie consistency. Images are taken of every swallow.

“We try to make it as palatable and realistic as you can,” says Rebecca Tekell, team lead speech language pathologist at Candler Hospital. “We have to have the Barium to see the swallow. Following protocol, we are looking at 17 components of a swallow from the lips all the way down to the esophagus, and the Barium helps us see if there’s any residue, anything that’s going down the wrong pipe or anything coming back up.”

Barium is safe, Trees adds, and it’s very uncommon for a patient to have GI upset or any other reaction to the Barium. After the study, Trees does recommend patients drink plenty of water.

Who would need a MBSS?

St. Joseph’s/Candler performs Modified Barium Swallow Studies at both hospitals. We do about 10 a week, Trees says. Patients can be of any age. For example, we can do MBSS on premature babies who are having trouble eating or infants or pediatrics who may have a congenital defect.

More commonly, an MBSS is used for adults with a variety of conditions including:

• Head and neck cancer patients
• Stroke patients
• Patients with chronic lung disease
• Some patients with dementia
• Patients with gastroenterology problems such as reflux or poor esophageal movement of food or liquids

What to expect during the appointment?

The study itself takes only about 10 minutes, but first you will meet with the speech language pathologist who will get some more information about the nature of your issue. All our speech language pathologists who perform these studies are MBSImP certified (The Modified Barium Swallow Impairment Profile).

During the X-ray, a radiologist runs the equipment and a radiology technician will help get the patient set up on the X-ray machine. The speech language pathologist will be in the room performing the study and providing the patient with the liquids and foods to swallow.

You do not have to fast or do any type of preparation before the exam, and afterwards, the main recommendation is to drink plenty of water.

After the study, the speech language pathologist will give you a general idea of the results and may even show you some of the images so you understand what’s going on. However, your referring physician will be the one to tell you the final results and recommendations for treatment going forward, Trees says.

What are some of the results?

“What I usually tell people is we expect the food and liquid to move through the throat. Once it hits the back of the tongue, it should take just about a second to move through the throat,” Trees says. “We don’t want to see any leftover in the throat. Obviously we don’t want to see anything going towards the airway, and we don’t want to see anything coming back up.”

Results vary from patient to patient. Some patients may have a normal swallow and be OK to follow a healthy diet. Others may be on the opposite end of the spectrum and have swallows so impaired the recommendation would be not to eat or drink anything and pursue alternative means of nutrition, Trees says.

In between, the swallow may only slightly be impaired and the treatment recommendation may be outpatient speech therapy or you may be referred to a gastroenterologist or Ear, Nose and Throat doctor for further testing and treatment.

The speech language pathologists share their results and their recommendations for further steps with the referring physician, who then makes the decision with the family on treatment plans.

“Our goal is always to, if possible, return the patient to as normal a diet as possible, and as normal a feeding situation as possible,” Trees says. “Along the way, we may have to make modifications and in the end, we may have to make more modifications, but the goal is to always push towards normal, while not putting the patient at risk for any other medical issues.”