Modified Barium Swallow: a Dietetic Intern's Perspective

By: Angela Farris, MA

During the 6th week of my clinical rotation I was able to participate in a Modified Barium Swallow (MBS) evaluation performed by a Speech Language Pathologist (SLP). In order for a patient to have a MBS performed they must have some sort of dysphagia, aka difficulty swallowing. The first step to determine if a patient has dysphagia is for a SLP to perform a bedside swallow evaluation. During this evaluation the SLP feeds the patient a number of liquids and foods to determine if the patient is at risk for aspiration. Have you ever had a drink or a piece of food "go down the wrong pipe"? If you have, you've aspirated. The problem is that if enough foreign body gets down into the lungs via aspiration bacteria can grown and an infection can spread making a patient very ill.

Below is a video showing a MBS with aspiration:

(aspiration occurs at 0:05 seconds; notice the dark liquid on the left)

The patient I followed failed their bedside swallow evaluation so the next step was to perform a Modified Barium Swallow. A MBS is a definitive way to check for any aspiration risk and determine the appropriate diet modification (i.e. mechanical soft, pureed, regular).

The SLP prepared 5 different test food/drinks for the patient to swallow; a graham cracker, applesauce, water, nectar-thick iced tea, and honey-thick juice. Each item received a barium-powder additive so that it would be easily viewed during the X-ray. Yes, the SLP encouraged me to try the powder -- and I did. Let's just say it makes everything taste like berry-flavored chalk!

I stood behind a protective wall and watched the MBS in real-time. It was amazing to visually see how our bodies have a natural rhythm while swallowing -- more muscles are involved than I could have imagined. It was a great experience and I'd like to see another before my clinical rotation comes to a close.

Here is a further description of modified textured liquids:

• Thin liquids: any regular beverage, ie water, juice, iced tea
• Nectar-thick liquids: easily pourable & are comparable to apricot nectar or thicker cream soups
• Honey-thick liquids: slightly thicker, less pourable, & drizzle from a cup or bowl
• Pudding-thick liquids: hold their own shape; are not pourable & are usually eaten with a spoon

The next time I take a drink or chew a piece of food, I will surely appreciate my ability to swallow!!