Barrett Esophagus

 Due to more severe reflux disease


image Hiatal hernia in almost all patients

image Mid esophageal mucosal irregularity, stricture, deep ulceration

image Risk of cancer > short-segment type


• Short segment: Columnar epithelium ≤ 3 cm above GE junction
image More common than long segment (reported in 2-12% of patients with chronic reflux at endoscopy)

image Due to less severe reflux disease

image Distal esophageal reticular mucosa, ± stricture, ± shallow ulceration




TOP DIFFERENTIAL DIAGNOSES




• Esophageal carcinoma

• Reflux esophagitis

• Candida esophagitis

• Viral esophagitis

• Radiation esophagitis

• Caustic esophagitis

• Drug-induced esophagitis

• Scleroderma


CLINICAL ISSUES




• Risk of adenocarcinoma based on morphology
image High risk: Midesophageal stricture, ulcer, reticular mucosa

image Moderate risk: Distal peptic stricture and reflux esophagitis

image Low risk: If none of above findings are present

• Diagnosis: Endoscopy with biopsy

image
(Left) Graphic shows a type 1 hiatal hernia, distal esophageal stricture, and nodular mucosal surface. Note the discrete ulcer image and an adenocarcinoma image represented by a raised sessile lesion with an irregular surface.


image
(Right) 2 views from an esophagram show a mid esophageal stricture image and ulcer in a patient with a small hernia image and reflux.

image
(Left) Endoscopic image shows a large ulcer image with the velvet texture of Barrett mucosa and stricture. Normal esophageal mucosa has a shiny, smooth, pink surface.


image
(Right) Two views from an esophagram show a polypoid mass image that represents an adenocarcinoma arising in Barrett mucosa.


TERMINOLOGY


Definitions




• Metaplasia of distal esophageal squamous epithelium to columnar epithelium


IMAGING


General Features




• Best diagnostic clue
image Mid esophageal stricture with hiatal hernia and reflux is essentially pathognomonic

• Other general features
image Acquired condition due to reflux esophagitis

image Premalignant condition associated with increased risk of esophageal adenocarcinoma
– Risk: 30-40x higher than in general population

– 90-100% of adenocarcinomas arise from Barrett mucosa


Radiographic Findings




• Double contrast esophagography is imaging of choice

• Classified into 2 types based on endoscopy and histopathologic findings
image Long segment: Columnar epithelium > 3 cm above gastroesophageal (GE) junction
– Due to more severe reflux disease

– Hiatal hernia in almost all patients

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Nov 16, 2016 | Posted by in GASTROINTESTINAL IMAGING | Comments Off on Barrett Esophagus

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