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, GERD, Esophageal Carcinoma 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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