Objectives: Barium studies are routinely requested to investigate a range of conditions, however, its efficacy for several conditions is unclear. Alongside findings from our audit in a district general hospital, we aim to review current literature on the use of barium swallow as an investigation for pharyngeal pouch, globus pharyngeus, tertiary peristalsis and oesophageal malignancy in adults. Methods: A systematic literature search was conducted on three databases for papers published in English in the last ten years. Following screening, six studies were included for pharyngeal pouch, five studies were included for globus pharyngeus, seven studies were included for tertiary peristalsis, and thirteen studies were included for oesophageal malignancy. Results: Barium swallow is a useful and important investigation in diagnosing pharyngeal pouch and can be useful to investigate oesophageal dysmotility in tertiary peristalsis. Globus pharyngeus patients do not clinically benefit from undergoing barium swallow. Oesophagogastroduodenoscopy (OGD) should remain as first line in diagnosing oesophageal malignancies. Conclusion: Barium swallow should be used to investigate pharyngeal pouch and tertiary peristalsis, but not used as the main investigation for globus pharyngeus or oesophageal malignancy. There is a need to develop further guidelines for investigations requested for dysphagia.