Barrett's esophagus differential diagnosis

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

Overview

Barrett's Oesophagus must be differentiated from Esophagitis, Peptic ulcer disease and Esophageal motor disorders.

Differentiating Barrett's Esophagus from other Diseases

  1. Pills esophagitis
  2. Eosinophilic esophagitis
  3. Infectious esophagitis[1]
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
  • Chest pain
  • Chronic cough
  • Laryngitis
  • Regurgitation
  • Heartburn
Normal
  • Mid or high esophageal ulcer
  • Mid or high esophageal web-like stricture
  • Reticular mucosal pattern
  • The esophageal lining appears pink or red and velvety. 
No any other test is done to diagnose Barrett's esophagus Esophageal Biopsy
Eosinophilic esophagitis Gradual + Progressive +/- +/- Normal
  • Multiple rings in the esophagus
  • Concentric rings of the esophagus- Trachealization of the esophagus
  • Increased serum IgE levels
  • Esophageal biopsy
Esophageal carcinoma
  • Gradual
+ + Progressive + +/- Normal
Case courtesy of Dr Bruno Di Muzio, Radiopaedia.org, rID: 4232f
  • CT and PET scan is an optional test for staging of the disease
Motor disorders

(Myasthenia gravis)

  • Gradual
+ + Progressive +/- Normal
  • Stasis in pharynx and pooling in pharyngeal recesses
  • Anti–acetylcholine receptor antibody test
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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