Barrett's esophagus differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Barrett's esophagus}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Barrett%27s_esophagus]]


{{CMG}}; {{AE}} {{AMK}}
{{CMG}}; {{AE}} {{AMK}}


==Overview==
==Overview==
Barrett's Oesophagus must be differentiated from [[Esophagitis]], [[Peptic ulcer disease]] and Esophageal motor disorders.
Barrett's esophagus must be differentiated from [[esophagitis]], [[peptic ulcer disease]], [[GERD]], [[esophageal carcinoma]] and esophageal motor disorders.


==Differentiating Barrett's Esophagus from other Diseases==
==Differentiating Barrett's Esophagus from other Diseases==
*[[Esophagitis]]
Barrett's esophagus should be differentiated from the following diseases;
# Pills [[esophagitis]]
*[[Esophagitis]]<ref name="pmid16798392">{{cite journal |author=Moayyedi P, Talley NJ |title=Gastro-oesophageal reflux disease |journal=Lancet |volume=367 |issue=9528 |pages=2086–100 |year=2006 |month=June |pmid=16798392 |doi=10.1016/S0140-6736(06)68932-0 |url=}}</ref>
# [[Eosinophilic esophagitis]]
** Pill [[esophagitis]]
# Infectious esophagitis<ref name="pmid16798392">{{cite journal |author=Moayyedi P, Talley NJ |title=Gastro-oesophageal reflux disease |journal=Lancet |volume=367 |issue=9528 |pages=2086–100 |year=2006 |month=June |pmid=16798392 |doi=10.1016/S0140-6736(06)68932-0 |url=}}</ref>
** [[Eosinophilic esophagitis]]
*[[GERD]]<ref>http://www.wrongdiagnosis.com/b/barretts_esophagus/misdiag.htm</ref>
** Infectious esophagitis
 
*[[GERD]]<ref>http://www.wrongdiagnosis.com/b/barretts_esophagus/misdiag.htm</ref><ref name="pmid25133039">{{cite journal| author=Badillo R, Francis D| title=Diagnosis and treatment of gastroesophageal reflux disease. | journal=World J Gastrointest Pharmacol Ther | year= 2014 | volume= 5 | issue= 3 | pages= 105-12 | pmid=25133039 | doi=10.4292/wjgpt.v5.i3.105 | pmc=4133436 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25133039  }} </ref>
* [[Esophageal carcinoma]] <ref name="pmid4021327">{{cite journal| author=Saenko VF, Tutchenko NI, Kurilets IP, Deĭneka SV, Malinin VV| title=[Diagnosis and surgical treatment of nonepithelial stomach tumors]. | journal=Klin Khir | year= 1985 | volume=  | issue= 5 | pages= 11-5 | pmid=4021327 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4021327  }} </ref>
* [[Peptic ulcer disease]]
* [[Peptic ulcer disease]]
* Esophageal motor disorders
* Esophageal motor disorders
 
<small><small>
 
===Preferred Table===
{| class="wikitable"
{| class="wikitable"
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease
Line 37: Line 38:
| align="center" style="background:#4479BA; color: #FFFFFF;" |Type
| align="center" style="background:#4479BA; color: #FFFFFF;" |Type
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal carcinoma]]
![[Barrett's esophagus]]
|
|Gradual
* Gradual
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|Progressive
|Progressive
| +
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|
|<nowiki>+</nowiki>
* [[Lymphadenopathy]]
|[[Gastroesophageal reflux disease|GERD]] [[Symptom|Symptoms]]
* [[Chest pain]]
 
* [[Chronic cough, severe cold|Chronic cough]]
 
* [[Laryngitis]]
 
* [[Regurgitation]]


* [[Cachexia]]
* [[Heartburn]]
|Normal
|Normal
|
|
* Irregular [[Strictures|stricture]]
* Mid or high [[esophageal ulcer]]
* Pre-stricture [[dilatation]]
* Mid or high [[Esophageal stricture|esophageal web-like stricture]]
[[Image:Oesophageal-squamous-cell-carcinoma-2.jpg|center|200px|thumb|Case courtesy of Dr Bruno Di Muzio, Radiopaedia.org, rID: 4232f]]
* Reticular mucosal pattern
|
|
* [[Esophageal]] obstruction
* The [[esophageal]] lining appears pink or red and velvety. 
* Staging of disease
<div style="width:350px">{{#ev:youtube|5ucSlgqGAno}}</div>
|
|
* [[CT]] and [[PET scan]] is an optional test for staging of the disease
* No any other test is done to diagnose Barrett's esophagus
|
|
* [[Biopsy]]
* [[Esophageal]] [[Biopsy]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Plummer-Vinson syndrome]]
![[Eosinophilic esophagitis]]
|
|Gradual
* Gradual
| +
| +
| -
|Non progressive
| +/-
| -
|
|
* [[Glossitis]]
* [[Koilonychia]]
|Normal
|
* Thin projections on the anterior [[esophageal]] wall
* Multiple upper [[Esophageal stricture|esophageal constrictions]]
[[Image:Plummer-vinson-syndrome.jpg|center|200px|thumb|Barium esophagogram (Source: Case courtesy of Dr Hani Salam, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/14029">rID: 14029</a>)]]
|
* Direct visualization of [[esophageal webs]]
* Superior to [[esophagogram]]
<div style="width:350px">{{#ev:youtube|HFfsTgsB6Pg}}</div>
|
* Videofluoroscopy shows [[mucosal]] and [[submucosal]] foldings
|
Triad of
* [[Iron deficiency anemia]]
* [[Esophageal webs]]
* [[Glossitis]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal stricture]]
|
* Gradual
* Sudden onset
| +
| -
|Progressive
|Progressive
| +/-
| +/-
| +/-
| +/-
|
|
* [[Odynophagia]]
* [[Chest pain]]
* Food impaction
* [[Cough]]
* [[Cough]]
* [[Chest pain]]
|Normal
|Normal
|
|
*Sacculations
* Multiple rings in the [[esophagus]]
*Fixed transverse folds
*[[Esophageal]] intramural pseudodiverticula   
[[Image:Benign-oesophageal-stricture.jpg|center|200px|thumb|Case courtesy of Dr Ahmed Abd Rabou, Radiopaedia.org, rID: 23008]]
|
|
* [[Mucosal]] edema
* [[Concentric]] rings of the [[esophagus]]- Trachealization of the [[esophagus]]
* Circumferential thickening in [[Gastroesophageal reflux disease|GERD]]
* Pale [[mucosa]] with white [[exudate]] in lymphocytic esophagitis
* [[Swelling]] and [[hemorrhagic]] [[congestion]] in [[caustic]]<nowiki/> ingestion
<div style="width:350px">{{#ev:youtube|vax5E-jMnQ}}</div>
|
|
* [[Manometry]] may show dysmotility
* Increased [[IgE|serum IgE]] levels
* [[CT scan]] for staging [[malignant]] [[strictures]]
|
|
* [[Esophagogram|Barium esophagogram]]
* [[Esophageal]] [[biopsy]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Diffuse esophageal spasm]]
! align="center" style="padding: 5px 5px; background: " |[[Esophageal carcinoma]]
|
* Sudden
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|Non progressive
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|
* [[Chest pain]]
 
|Normal
|
* Nonperistaltic and nonpropulsive contractions
* Corkscrew or rosary bead esophagus
[[Image:DES radio.png|center|200px|thumb|Barium swallow appearance of DES<br>Source:By Nevit Dilmen [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)]]
|
* Inconclusive
<div style="width:350px">{{#ev:youtube|2ipA34iMA3c}}</div>
|
*[[Manometry]] shows high-amplitude [[esophageal]] contractions
*[[CT scan]] may show [[hypertrophy]] of esophageal muscles
|
* [[Manometry]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Achalasia]]
|
|
* Gradual
* Gradual
| +
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|Non progressive
| +/-
| -
|
* [[Regurgitation]] of undigested food
* [[Chest pain]]
|Normal
|
* "Bird's beak" or "rat tail" appearance
* Dilated esophageal body
* Air fluid level (absent [[peristalsis]])
* Absence of an intragastric air bubble
[[Image:Achalasia-2.jpg|center|200px|thumb|Case courtesy of Dr Mario Umana, Radiopaedia.org, rID: 38071]]
|
* Dilated [[esophagus]]
* Residual food fragments
* Normal [[mucosa]]
<div style="width:350px">{{#ev:youtube|ydLcskQzEjM}}</div>
|
* Residual pressure of [[Lower esophageal sphincter|LES]] > 10 mmHg
* Incomplete relaxation of the [[Lower esophageal sphincter|LES]]
* Increased resting tone of [[Lower esophageal sphincter|LES]]
* Aperistalsis
|
* History of [[dysphagia]] with positive [[endoscopy]] and [[manometry]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Systemic sclerosis]]
|
* Gradual
| +
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|Progressive
|Progressive
| +/-
| +
| +
|<nowiki>+/-</nowiki>
|
|
* [[Muscle pain|Muscle]] and [[Arthralgia|joint pain]]
* [[Lymphadenopathy]]


* [[Raynaud's phenomenon]]
* [[Cachexia]]
 
* [[Skin changes]]  
|Normal
|Normal
|
|
* Dysmotility
* Irregular [[Strictures|stricture]]
 
* Pre-stricture [[dilatation]]
* Patulous [[esophagus]]
[[Image:Oesophageal-squamous-cell-carcinoma-2.jpg|center|200px|thumb|Case courtesy of Dr Bruno Di Muzio, Radiopaedia.org, rID: 4232f]]
|
|
* [[Mucosal]] damage
* [[Esophageal]] [[obstruction]]
 
* [[Cancer staging|Staging]] of [[disease]]
* [[Peptic]] stricture (advanced cases)
|Positive serology for
* [[Antinuclear antibodies]]
 
* [[Rheumatoid factor]]
 
* [[Creatine kinase]]
 
* [[ESR]]
|
|
* [[Skin biopsy]]
* [[CT]] and [[PET scan]] is an optional test for [[Cancer staging|staging]] of the [[disease]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Zenker's diverticulum]]
|
|
* Gradual
* [[Biopsy]]
| +
|<nowiki>-</nowiki>
|
| +/-
| -
|
* Food [[regurgitation]]
 
* [[Halitosis]]
 
* [[Coughing|Cough]]
 
* [[Hoarseness]]
|Normal
|
* Thin projections on [[esophageal]] wall over [[Killian's dehiscence|Killian's triangle]]
[[Image:Zenker-4.jpg|center|200px|thumb| Radiopaedia.org">{{cite web |url=https://radiopaedia.org/cases/zenker-diverticulum |title=Zenker diverticulum &#124; Radiology Case &#124; Radiopaedia.org |format= |work= |accessdate=}}<nowiki></ref></nowiki>]]
|
* Outpouching of posterior [[pharyngeal]] wall
 
* Exclude the presence of [[Squamous cell carcinoma|SCC]]
<div style="width:350px">{{#ev:youtube|FdEruFsNdVA}}</div> 
|
* [[CT]] & [[MRI]] shows out-pouching over the posterior esophagus in the Killian's triangle
|
* Barium [[Esophagogram|esophagography]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Stroke]]
([[Cerebral hemorrhage]])
|
* Sudden
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|Progressive
|<nowiki>+</nowiki>
|<nowiki>+/-</nowiki>
|
* [[Dysarthria]]
 
* Limb [[weakness]]
 
* [[Fatigue]]
|Impaired
|
* Pooling of [[Contrast medium|contrast]] in the [[pharynx]]
* [[Aspiration]] of [[barium]] [[Contrast medium|contrast]] into the [[airway]]
|
* Reduced opening of [[upper esophageal sphincter]]
* Reduced [[larynx]] elevation
|
* [[CT]] without [[contrast]] shows acute [[hemorrhage]] as a hyperattenuating [[clot]]
|
* [[CT]] without [[Contrast medium|contrast]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Motor disorders
! align="center" style="padding: 5px 5px; background: " |Motor disorders
([[Myasthenia gravis]])
([[Myasthenia gravis]])
|
|
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|Progressive
|Progressive
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|
| -
|
|
* [[Ptosis]]
* [[Ptosis]]
Line 289: Line 128:
|Normal
|Normal
|
|
* Stasis in [[pharynx]] and pooling in pharyngeal recesses
* [[Stasis]] in [[pharynx]] and pooling in [[pharyngeal]] recesses
|
|
* [[Velopharyngeal insufficiency]]
* [[Velopharyngeal insufficiency]]
* Delayed [[swallowing]] function
* Delayed [[swallowing]] function
|
|
* CT may show anterior [[mediastinal]] mass ([[thymoma]])  
* [[CT-scans|CT]] may show anterior [[mediastinal]] mass ([[thymoma]])  
* Positive tensilon test  
* Positive tensilon test  
|
|
* Anti–acetylcholine receptor antibody test
* Anti–[[acetylcholine receptor]] [[antibody test]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[GERD]]
! align="center" style="padding: 5px 5px; background: " |[[GERD]]
|
|
* Gradual
* Gradual
Line 315: Line 154:
|Normal
|Normal
|
|
* Free acid reflux
* Free [[acid reflux]]
* [[Esophagitis]] with scarring
* [[Esophagitis]] with [[scarring]]
* [[Strictures]]
* [[Strictures]]
* [[Barrett's oesophagus]]
* [[Barrett's oesophagus]]
Line 323: Line 162:
* [[Barrett's esophagus]]
* [[Barrett's esophagus]]
|
|
* Esophageal [[manometry]] may show decreased tone of [[Lower esophageal sphincter|LES]]
* [[Esophageal]] [[manometry]] may show decreased tone of [[Lower esophageal sphincter|LES]]
|
|
* 24 hour [[esophageal]] pH monitoring
* 24 hour [[esophageal]] [[pH]] monitoring
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal web]]
|
* Gradual
| +
| +/-
|Progressive
| -
| +/-
|
* Findings of the underlying cause such as [[iron deficiency anemia]] or [[bullous pemphigoid]]
|Normal
|
* Symmetrical narrowing of the [[esophagus]]
|
* Smooth membrane not encircling the whole [[Lumen (anatomy)|lumen]]
|
* Videofluoroscopy shows [[mucosal]] and [[submucosal]] foldings
|
* Barium [[esophagogram]]
|}
 
===Use if the above table can not be made===
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Similar Features}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Differentiating Features}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 1
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 2
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 3
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 4
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 5
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|}
|}


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{{WS}}
{{WS}}
[[Category: (name of the system)]]
[[Category: (name of the system)]]
[[Category:Differential diagnosis]]

Latest revision as of 22:00, 7 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amresh Kumar MD [2]

Overview

Barrett's esophagus must be differentiated from esophagitis, peptic ulcer disease, GERD, esophageal carcinoma and esophageal motor disorders.

Differentiating Barrett's Esophagus from other Diseases

Barrett's esophagus should be differentiated from the following diseases;

Disease Signs and Symptoms Barium esophagogram Endoscopy Other imaging and laboratory findings Gold Standard
Onset Dysphagia Weight loss Heartburn Other findings Mental status
Solids Liquids Type
Barrett's esophagus Gradual + - Progressive +/- + GERD Symptoms Normal
  • The esophageal lining appears pink or red and velvety. 
  • No any other test is done to diagnose Barrett's esophagus
Eosinophilic esophagitis Gradual + Progressive +/- +/- Normal
Esophageal carcinoma
  • Gradual
 + + Progressive + +/- Normal
Case courtesy of Dr Bruno Di Muzio, Radiopaedia.org, rID: 4232f
Motor disorders

(Myasthenia gravis)

  • Gradual
 + + Progressive +/- - Normal
GERD
  • Gradual
  • Sudden onset
 + - Progressive +/- + Normal

References

  1. ↑ Moayyedi P, Talley NJ (2006). "Gastro-oesophageal reflux disease". Lancet. 367 (9528): 2086–100. doi:10.1016/S0140-6736(06)68932-0. PMID 16798392. Unknown parameter |month= ignored (help)
  2. ↑ http://www.wrongdiagnosis.com/b/barretts_esophagus/misdiag.htm
  3. ↑ Badillo R, Francis D (2014). "Diagnosis and treatment of gastroesophageal reflux disease". World J Gastrointest Pharmacol Ther. 5 (3): 105–12. doi:10.4292/wjgpt.v5.i3.105. PMC 4133436. PMID 25133039.
  4. ↑ Saenko VF, Tutchenko NI, Kurilets IP, Deĭneka SV, Malinin VV (1985). "[Diagnosis and surgical treatment of nonepithelial stomach tumors]". Klin Khir (5): 11–5. PMID 4021327.

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