A barium esophagram or swallow is used as an initial diagnostic test for several esophageal conditions such as Barrett's esophagus, dysphagia (difficulty swallowing) as well as complications such as stricture, obstruction, narrowing, ulcers and tumors. During this procedure, the patient swallow barium, a while, chalky substance, which can then be viewed via x-ray. Using this procedure the physician can view many abnormalities associated with the esophagus. The disadvantage of this procedure is that it can miss smaller ulcers and tumors. This test is also not very effective for diagnosing gastroesophageal reflux associated with GERD. Approximately, 40% of the time, reflux my occur in normal patients, while those suffering from GERD will not have reflux during the procedure.