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Barrett's Esophagus

David I Rose, MD
Harry Z Mellins, MD

July 1, 1996

Presentation

A woman presented with a history of gastroesophageal reflux and heartburn.

Imaging Findings

Double contrast barium esophagram

A double-contrast barium esophogram demonstrates a relatively smooth, nondistensible, tapered area of narrowing in the mid-to-distal esophagus (arrow). The mucosa at this level is finely reticular.

Differential Diagnosis

Uncomplicated peptic strictures are a consideration in patients with gastroesophageal reflux. In addition, caustic ingestion, mediastinal irradiation, primary or metastatic tumors, and esophageal involvement with dermatologic disorders such as epidermolysis bullosa dystrophica or benign mucous membrane pemphigoid may have this radiologic appearance. These conditions can be differentiated from Barrett's esophagus by clinical history and presentation.

Diagnosis

Barrett's esophagus

Discussion

Barrett's esophagus is a metaplastic condition in which there is replacement of the normal squamous mucosa of the esophagus above the lower esophageal sphincter with a columnar gastric or intestinal type of mucosa. It is predominantly acquired as a protective mechanism against long-standing gastroesophageal reflux and subsequent reflux esophagitis. The columnar epithelium is more resistant to injury from refluxing gastric contents. It is rarely seen congenitally. The prevalence of Barrett's esophagus in patients with reflux esophagitis is about 10%. Barrett's metaplasia is considered to be a premalignant condition associated with a significantly increased risk of developing esophageal adenocarcinoma.

On double-contrast barium esophograms, Barrett's metaplasia may appear, as in this patient, with a smooth, nondistensable, tapered narrowing of the mid-to-distal esophagus. However, it may also appear as a high esophageal ring-like stricture or ulcer, often associated with a sliding hiatal hernia or gastroesophageal reflux. A reticular mucosal pattern has also been described as a relatively specific sign of Barrett's esophagus, particularly if associated with a stricture. In addition, focal mural deformity associated with fixed transverse folds and limited distensibility of the esophagus has been associated with Barrett's esophagus.

References

1. Levine MS. Gastroesophageal reflux disease. In: Gore RM, Levine MS, Laufer I, editors. Textbook of Gastrointestinal Radiology. Philadelphia: Saunders, 1994:377-382.

2. Levine MS, Laufer I. Esophagus. In: Laufer I, Levine MS, editors. Double contrast gastrointestinal radiology. 2nd edition. Philadelphia: Saunders, 1992:131-133.

3. Glick SN. Barium studies in patients with Barrett's esophagus: Importance of focal areas of esophageal deformity. American Journal of Roentology 1994; 163:65-67.

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