Standardization of clinical criteria required for use of the 12.5 millimeter barium tablet in evaluating esophageal lumenal patency

Background: Although the barium tablet is commonly used in evaluating lumenal patency of the esophagus, the conditions under which the tablet should traverse a normal esophagus have not been established. This study was designed to standardize the minimal criteria required to ensure successful esophageal transit of a commercially available barium tablet in normal subjects. Methods: Each of 20 volunteers swallowed a standard 12.5 mm barium tablet under fluoroscopy in the supine, 45° incline, and upright positions. Tablets were swallowed dry and with fixed volumes of water (15, 30, 60, and 100 cc). Success of pill passage into the stomach was determined by fluoroscopy at 20, 40, 60, and 90 seconds. Results: Successful pill passage correlated significantly with position (passing 17.0%, 66.5%, and 69.7% in the supine, incline, and upright position, respectively; p < .0001) and volume of water ingested (passing 9.1% when swallowing dry, and 38.7%, 55.8%, 70.0%, and 81.6% with 15, 30, 60, and 100 cc of water, respectively; p ≤ .004). Duration of time beyond 20 seconds failed to affect rate of pill passage. Ingestion of 60 cc of water in the incline position was associated with a 95% pill passage, a rate significantly greater than any position at lower volumes. Increasing water volume above 60 cc or assuming the upright position did not increase this passage rate further. Conclusions: The minimum criteria required to optimize successful transit of a 12.5 mm barium tablet through a normal esophagus is to perform the test in the 45° incline position with 60 cc of water for a period of 20 seconds. Failure of the pill to pass under these conditions may suggest a true structural abnormality of the esophagus.