Modified Barium Swallowing Test

A Modified Barium Swallow (MBS) test is an X-ray that is taken to check the swallowing skills of a client or patient. I recently observed an MBS in a patient who has been cancer-free for nearly 10 years but, was aspirating when he swallowed certain foods and beverages. The MBS was carried out by a Speech Language Pathologist (SLP) at the facility that I’m rotating at currently. The SLP had previously worked with this patient and mentioned that he had developed fibrous tissue along his esophagus, caused by his radiation treatment several years earlier. This was her initial assessment of the patient’s swallowing problems.

Throughout the test, the mouth, throat, and esophagus are checked to see if there are any visible problems with a patient’s ability to swallow.  Before we began the test, the SLP and I put on protective lead vests and a thyroid collar. This was done to shield ourselves from the radiation used in the actual test.

Barium is actually a dry, white, chalky powder that is mixed with water to make thick, almost like the consistency of a milkshake. It is an X-ray absorber and appears white on X-ray film. When swallowed, a barium drink coats the inside walls of the pharynx and esophagus so that the swallowing motion, inside wall lining, and size and shape of these organs is visible on X-ray. This process shows differences that might not be seen on standard X-rays. Barium is used only for diagnostic studies of the GI tract. The use of barium with X-rays contributes to the visibility of various characteristics of the pharynx and esophagus. Some abnormalities of the pharynx and/or esophagus that may be detected by a barium swallow include tumors, ulcers, hernias, diverticula (pouches), strictures (narrowing), inflammation, and swallowing difficulties.

The SLP noted that if she were to have assessed this patient bedside, she probably would have missed that he has aspirating when he swallowed. The MBS really caught the problem that the patient was actually having. It was interesting to see how everything looked through the MBS and to see how problems can go unnoticed.

The SLP was really hands-on and pointed out every part of the patient’s anatomy including his epiglottis, esophagus, stomach, tongue, etc. I can honestly say that working with patients who suffer from dysphagia or who are experiencing temporary swallowing problems is really becoming an interest of mine. There’s so many elements that an RD has to take into consideration, for example consistencies of beverages and foods or physiological problems from cancer treatments.

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How to Fight Heartburn and Reflux

How to Fight Heartburn and Reflux

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A substantial amount of Americans suffer from “acid indigestion” or “heartburn.” Others may be diagnosed with GERD: Gastroesophageal Reflux Disease. These conditions may be triggered by the “typical” American diet and lifestyle habits. The occurrence of these symptoms has increased with the growing epidemic of obesity.  

Well, let’s break the issues down… What are these conditions? How can we address their symptoms?

In heartburn and reflux, acid from the stomach flows upward into the lower end of the esophagus. This can be caused by pressure pushing upward, or relaxation of the otherwise tight muscle that normally keeps acid in the stomach. Pressure can be caused by overeating at a meal, pregnancy, some types of exercise, or being overweight. In the case of the muscle, it can be affected by actual changes in the muscle or substances that relax the muscle. The symptoms, in turn, can be a burning sensation and/or pain.

Foods, beverages, and even certain medications can cause the muscle to relax. Stress, lack of sleep and smoking can also contribute to indigestion. Eating, especially large amounts before bedtime is another element.

Despite the name, heartburn is not a condition of the heart, but the symptoms can mimic heart conditions. Regrettably, some people dismiss symptoms of heart complications, by blaming them on indigestion. Random indigestion or heartburn is not a problem. When it occurs on a regular basis, as in GERD, it can cause ulceration in the esophagus, bleeding ulcers, and an increased risk of esophageal cancer.

GERD is diagnosed when the reflux becomes more chronic and problematic. This occurs more than twice a week, becomes worse even with increasing doses of OTC antacids, causes problems with sleep, interferes with normal activities, causes hoarseness or worsening of asthma, invokes a chronic cough, causes chest pain, causes trouble swallowing, or causes a loss of appetite due to symptoms.

As the article stated before, there are some foods that contribute to the cause of reflux, while other foods are more likely to irritate already inflamed tissues. Examples of trigger foods that can cause relaxation of the muscle would be fatty foods, alcohol, chocolate, coffee, tomato, onion, garlic, mint, caffeine and carbonated beverages.

Foods that cause physical irritation might be abrasive grain foods (like some crackers or dry cereals), nuts, or some raw vegetables. Others might be acidic foods (citrus fruit/juices, tomato products) or spicy foods (pepper, chili powder, curry). Try using softer foods and beverages to provide nutrient needs when the esophagus is irritated.

When it comes to fiber, try including more soluble fiber foods found in oats, cooked vegetables and skinned fruit. Cooking raw vegetables like steaming or roasting can reduce the abrasion. It can be helpful to keep a food and beverage record, as well as a symptom record to identify any triggers.

Other habits that can be helpful might be eating smaller, frequent meals (rather than a few large meals), eating slowly, and chewing food thoroughly. You should also try stopping eating about two to three hours before bedtime and sleeping with your upper body elevated. Keep up with fluid intake, which is at least 64oz. spread throughout the entire day.

If being overweight is contributing to the reflux, weight loss would be an option. Healthy weight loss should be achieved by eating smaller portions of healthy foods spread over at a minimum of 3 meals. This pattern can help reduce total calorie intake while sustaining energy levels and putting you in better control over food choices. The smaller portions and more consistent food intake can directly improve the reflux as well. You should also make sure that your diet is nutritionally adequate, since some foods may be limited owing to reduced food intake and because you are avoiding reflux triggers.

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Heartburn/Reflux article