Advertisement

Gastrointestinal Radiology

, Volume 11, Issue 1, pp 123–130 | Cite as

Radiologic diagnosis of Barrett's esophagus: Critical analysis of 65 cases

  • Farooq P. Agha
Article

Abstract

A recent increase in the number of Barrett's esophagis being diagnosed is probably directly related to a proportional increase in endoscopic biopsies of the esophagus and awareness of premalignant potential of Barrett's mucosa. While the endoscopist can detect Barrett's mucosa with fair degree of accuracy, the radiologic diagnosis of Barrett's esophagus still remains a diagnostic challenge despite several well established radiologic features. We reviewed 65 patients with pathologically proven Barrett's esophagus and found a wide spectrum of radiologic features. These include hiatus hernia in 49, gastroesophageal reflux in 38, strictures in 32, esophagitis in 20, and characteristic Barrett's ulcer in 12. In addition ascending or migrating strictures were found in 10, mucosal pattern simulating areae gastricae in 5, cricopharyngeal dysfunction in 4, and fixed spiral folds in 3 patients. This constellation of radiologic features, some of which have not been previously emphasized, should further assist radiologists in suggesting the diagnosis of Barrett's esophagus.

Key words

Barrett's esophagus, radiologic diagnosis Esophagus, inflammation 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Barrett NR: Chronic peptic ulcer of the esophagus and esophagitis.Br J Surg 38:175–182, 1950PubMedGoogle Scholar
  2. 2.
    Barrett NR: The lower esophagus lined by columnar epithelium.Surgery 41:881–894, 1957PubMedGoogle Scholar
  3. 3.
    Allison PR, Johnstone AS: The esophagus lined with gastric mucous membrane.Thorax 8:87–101, 1953PubMedGoogle Scholar
  4. 4.
    Morris KN: Gastric mucosa within the esophagus.Aust NZ J Surg 25:24–30, 1955Google Scholar
  5. 5.
    Cohen BR, Wolf BS, Som M, Janowitz HD: Correlation of manometric, oesophagoscopic and radiological findings in the columnar-lined gullet (Barrett syndrome).Gut 4:406–412, 1963Google Scholar
  6. 6.
    Mossberg SM: The columnar lined oesophagus (Barrett syndrome); an acquired condition?Gastroenterology 50:671–676, 1966PubMedGoogle Scholar
  7. 7.
    Adler RH: The lower esophagus lined by columnar epithelium; its association with hiatus hernia, ulcer, stricture and tumor.J Thorac Cardiovasc Surg 45:13–32, 1963PubMedGoogle Scholar
  8. 8.
    Burgess JN, Payne WS, Anderson HA, Weiland LH, Carlson HC: Barrett's esophagus, the columnar epithelial lined lower esophagus.Mayo Clin Proc 46:728–734, 1971PubMedGoogle Scholar
  9. 9.
    Trier JS: Morphology of the epithelium of the distal esophagus in patients with mid esophageal peptic strictures.Gastroenterology 58:444–461, 1970PubMedGoogle Scholar
  10. 10.
    Abram L, Heath D: Lower esophagus lined with intestinal and gastric epithelia.Thorax 20:66–72, 1965PubMedGoogle Scholar
  11. 11.
    Bremner CG, Lynch VP, Ellis FH: Barrett's esophagus: congenital or acquired? An experimental study of esophageal mucosal regeneration in the dog.Surgery 68:209–216, 1970PubMedGoogle Scholar
  12. 12.
    Hamilton SR, Yardley JH: Regeneration of cardiac type mucosa and acquisition of Barrett's mucosa after esophago-gastrectomy.Gastroenterology 72:669–675, 1977PubMedGoogle Scholar
  13. 13.
    Naef AP, Savary M, Ozello L: Columnar lined lower esophagus: an acquired lesion with malignant predisposition.J Thorac Cardiovasc Surg 70:826–835, 1975PubMedGoogle Scholar
  14. 14.
    Goldman MC, Beckman RC: Barrett's syndrome: case report with discussion about concepts of pathogenesis.Gastroenterology 39:104–110, 1960PubMedGoogle Scholar
  15. 15.
    Vieux U, Dave P, Joseph Y: Barrett's esophagus; unusual features.Mt Sinai J Med (NY) 48:58–60, 1981Google Scholar
  16. 16.
    Mangla JC: Barrett's esophagus: an old entity rediscovered.J Clin Gastroenterol 3:347–356, 1981PubMedGoogle Scholar
  17. 17.
    Messian RA, Hermos UA, Robbins AH, Friedlander DM, Schimmel EM: Barrett's esophagus; clinical review of 26 cases.Am J Gastroenterol 69:458–466, 1978PubMedGoogle Scholar
  18. 18.
    Stadelmann O, Elster K, Kuhn HA: Columnar lined oesophagus (Barrett's syndrome); congenital or acquired?Endoscopy 13:140–147, 1981PubMedGoogle Scholar
  19. 19.
    Bremner CG: The columnar lined (Barrett's) esophagus. In Nyhus L (ed):Surgery Annual. New York: Appleton-Century-Crofts, 1977Google Scholar
  20. 20.
    Borrie J, Goldwater L: The columnar lined esophagus: assessment of etiology and treatment. A 22 year experience.J Cardiovasc Thorac Surg 71:825–834, 1976Google Scholar
  21. 21.
    Som ML, Wolf BS: Peptic ulcer of the esophagus and esophagitis in gastric lined esophagus.JAMA 162:641–644, 1956Google Scholar
  22. 22.
    Wolf BS, Marshak RH, Som ML: Peptic esophagitis and peptic ulceration of the esophagus.AJR 79:741–759, 1958Google Scholar
  23. 23.
    Som ML, Shapiro JH, Jacobson HC: The “gastric lined” esophagus with esophagitis.Radiology 69:856–859, 1957PubMedGoogle Scholar
  24. 24.
    Missakian MM, Carlson HC, Anderson HA: The roentgenologic features of the columnar epithelial lined lower esophagus.AJR 99:212–217, 1967Google Scholar
  25. 25.
    Robbins AH, Hermos JA, Schimmel EM, Friedlander DM, Messian RA: The columnar lined esophagus: analysis of 26 cases.Radiology 123:1–7, 1977PubMedGoogle Scholar
  26. 26.
    Robbins AH, Vincent ME, Saini M, Schimmel EM: Revised radiologic concepts of the Barrett's esophagus.Gastrointest Radiol 3:377–381, 1978PubMedGoogle Scholar
  27. 27.
    Levine MS, Kressel HY, Caroline DF, Laufer I, Herlinger H, Thompson JJ: Barrett's esophagus: reticular pattern of the mucosa.Radiology 147:663–667, 1983PubMedGoogle Scholar
  28. 28.
    Pauli A, Trier JS, Dalton MD: The histologic spectrum of Barrett's esophagus.N Engl J Med 295:476–480, 1976PubMedGoogle Scholar
  29. 29.
    Endo M, Kobayashi S, Kosu T, Kakemodo T, Nakayama K: A case of Barrett's epithelialization followed up for five years.Endoscopy 6:48–51, 1974Google Scholar
  30. 30.
    Spechler SJ, Schimmel EM, Dalton JW, Doos W, Trier JS: Barrett's epithelium complicating lye ingestion with sparing of the distal esophagus.Gastroenterology 81:580–583, 1981PubMedGoogle Scholar
  31. 31.
    Smiley TB, Caves PK, Porter DC: Relationship between posterior pharyngeal pouch and hiatus hernia.Thorax 25:725–731, 1970PubMedGoogle Scholar
  32. 32.
    Gerhardt DC, Shuck TJ, Bordeaux RA, Winship WH: Upper esophageal sphincter: response to volume, osmotic and acid stimuli.Gastroenterology 75:268–274, 1978Google Scholar
  33. 33.
    Gray JE, Lockard O, Shuck TJ, Winship DH: Response of the upper esophageal sphincter and upper esophageal intraluminal esophageal distension.Gastroenterology 76: A 1143, 1979Google Scholar
  34. 34.
    Ellis FH, Schlegel JF, Lynch VP, Payne WS: Cricopharyngeal myotomy for pharyngoesophageal diverticulum.Ann Surg 170:340–349, 1969PubMedGoogle Scholar
  35. 35.
    Knuff TE, Benjamin SB, Castell DO: Pharyngoesophageal (Zenker's) diverticulum: a reappraisal.Gastroenterology 82:734–736, 1982PubMedGoogle Scholar
  36. 36.
    Swishchuk LE, Hayden CK, Van Caillie BD: Mega-aeroesophagus in children. A sign of gastroesophageal reflux.Radiology 141:73–76, 1981PubMedGoogle Scholar
  37. 37.
    Levine MS, Goldstein HM: Fixed transverse folds: a sign of reflux esophagitis.AJR 143:275–278, 1984PubMedGoogle Scholar
  38. 38.
    Trier JS, Curtis RL: Barrett's esophagus. In Sherlock P Jerry Glass G (eds):Progress in Gastroenterology. New York: Grune and Stratton, 1983, pp 231–250Google Scholar
  39. 39.
    Sjogren RW Jr, Johnson LF: Barrett's esophagus: a review.Am J Med 74:313–321, 1983PubMedGoogle Scholar
  40. 40.
    Bozymski EM, Herlihy KJ, Orlando RC: Barrett's esophagus.Ann Intern Med 97:103–107, 1982PubMedGoogle Scholar
  41. 41.
    Agha FP, Dabich L: Barrett's esophagus complicating scleroderma.Gastrointest Radiol 10:325–329, 1985PubMedGoogle Scholar
  42. 42.
    Feczko PJ, Chan KM, Halpert RD, Batra SK: Barrett's metaplasia and dysplasia in postmyotomy archalasia patients.Am J Gastroenterol 78:265–268, 1983PubMedGoogle Scholar
  43. 43.
    Agha FP: Esophageal involvement in Zollinger Ellison syndrome.AJR 145:721–725, 1985Google Scholar
  44. 44.
    Meyer W, Vollmer F, Bar W: Barrett's esophagus following total gastrectomy. A contribution to its genesis.Endoscopy 12:121–126, 1979Google Scholar
  45. 45.
    Barardi RS, Devaiah KA: Barrett's esophagus (collective review).Surg Gynecol Obstet 183:521–538, 1983Google Scholar

Copyright information

© Springer-Verlag 1986

Authors and Affiliations

  • Farooq P. Agha
    • 1
  1. 1.Department of RadiologyUniversity of Michigan HospitalsAnn ArborUSA

Personalised recommendations