Barrett's esophagus differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Barrett's esophagus}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Barrett%27s_esophagus]]


{{CMG}}; {{AE}} {{AMK}}
{{CMG}}; {{AE}} {{AMK}}


==Overview==
==Overview==
Barrett's Oesophagus must be differentiated from [[Esophagitis]], [[Peptic ulcer disease]] and Esophageal motor disorders.
Barrett's esophagus must be differentiated from [[esophagitis]], [[peptic ulcer disease]], [[GERD]], [[esophageal carcinoma]] and esophageal motor disorders.


==Differentiating Barrett's Esophagus from other Diseases==
==Differentiating Barrett's Esophagus from other Diseases==
*[[Esophagitis]]
Barrett's esophagus should be differentiated from the following diseases;
# Pills [[esophagitis]]
*[[Esophagitis]]<ref name="pmid16798392">{{cite journal |author=Moayyedi P, Talley NJ |title=Gastro-oesophageal reflux disease |journal=Lancet |volume=367 |issue=9528 |pages=2086–100 |year=2006 |month=June |pmid=16798392 |doi=10.1016/S0140-6736(06)68932-0 |url=}}</ref>
# [[Eosinophilic esophagitis]]
** Pill [[esophagitis]]
# Infectious esophagitis<ref name="pmid16798392">{{cite journal |author=Moayyedi P, Talley NJ |title=Gastro-oesophageal reflux disease |journal=Lancet |volume=367 |issue=9528 |pages=2086–100 |year=2006 |month=June |pmid=16798392 |doi=10.1016/S0140-6736(06)68932-0 |url=}}</ref>
** [[Eosinophilic esophagitis]]
*[[GERD]]<ref>http://www.wrongdiagnosis.com/b/barretts_esophagus/misdiag.htm</ref>
** Infectious esophagitis
 
*[[GERD]]<ref>http://www.wrongdiagnosis.com/b/barretts_esophagus/misdiag.htm</ref><ref name="pmid25133039">{{cite journal| author=Badillo R, Francis D| title=Diagnosis and treatment of gastroesophageal reflux disease. | journal=World J Gastrointest Pharmacol Ther | year= 2014 | volume= 5 | issue= 3 | pages= 105-12 | pmid=25133039 | doi=10.4292/wjgpt.v5.i3.105 | pmc=4133436 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25133039  }} </ref>
* [[Esophageal carcinoma]] <ref name="pmid4021327">{{cite journal| author=Saenko VF, Tutchenko NI, Kurilets IP, Deĭneka SV, Malinin VV| title=[Diagnosis and surgical treatment of nonepithelial stomach tumors]. | journal=Klin Khir | year= 1985 | volume=  | issue= 5 | pages= 11-5 | pmid=4021327 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4021327  }} </ref>
* [[Peptic ulcer disease]]
* [[Peptic ulcer disease]]
* Esophageal motor disorders
* Esophageal motor disorders
<small><small>
{| class="wikitable"
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease
! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" |Signs and Symptoms
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Barium esophagogram
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Endoscopy
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Other imaging and laboratory findings
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Gold Standard
|-
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Onset
| colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Dysphagia
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Weight loss
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Heartburn
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Other findings
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Mental status
|-
| align="center" style="background:#4479BA; color: #FFFFFF;" |Solids
| align="center" style="background:#4479BA; color: #FFFFFF;" |Liquids
| align="center" style="background:#4479BA; color: #FFFFFF;" |Type
|-
![[Barrett's esophagus]]
|Gradual
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|Progressive
|<nowiki>+/-</nowiki>
|<nowiki>+</nowiki>
|[[Gastroesophageal reflux disease|GERD]] [[Symptom|Symptoms]]
* [[Chest pain]]
* [[Chronic cough, severe cold|Chronic cough]]
* [[Laryngitis]]


* [[Regurgitation]]


===Preferred Table===
* [[Heartburn]]
===Use if the above table can not be made===
|Normal
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
|
| valign="top" |
* Mid or high [[esophageal ulcer]]
|+
* Mid or high [[Esophageal stricture|esophageal web-like stricture]]
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
* Reticular mucosal pattern
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Similar Features}}
|
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Differentiating Features}}
* The [[esophageal]] lining appears pink or red and velvety. 
|
* No any other test is done to diagnose Barrett's esophagus
|
* [[Esophageal]] [[Biopsy]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 1
![[Eosinophilic esophagitis]]
| style="padding: 5px 5px; background: #F5F5F5;" |
|Gradual
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| +
| style="padding: 5px 5px; background: #F5F5F5;" |
|
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|Progressive
| +/-
| +/-
|
* [[Chest pain]]
* Food impaction
* [[Cough]]
|Normal
|
* Multiple rings in the [[esophagus]]
|
* [[Concentric]] rings of the [[esophagus]]- Trachealization of the [[esophagus]]
|
* Increased [[IgE|serum IgE]] levels
|
* [[Esophageal]] [[biopsy]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 2
! align="center" style="padding: 5px 5px; background: " |[[Esophageal carcinoma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
|
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
* Gradual
| style="padding: 5px 5px; background: #F5F5F5;" |
|<nowiki>+</nowiki>
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|<nowiki>+</nowiki>
|Progressive
| +
|<nowiki>+/-</nowiki>
|
* [[Lymphadenopathy]]
 
* [[Cachexia]]
|Normal
|
* Irregular [[Strictures|stricture]]
* Pre-stricture [[dilatation]]
[[Image:Oesophageal-squamous-cell-carcinoma-2.jpg|center|200px|thumb|Case courtesy of Dr Bruno Di Muzio, Radiopaedia.org, rID: 4232f]]
|
* [[Esophageal]] [[obstruction]]
* [[Cancer staging|Staging]] of [[disease]]
|
* [[CT]] and [[PET scan]] is an optional test for [[Cancer staging|staging]] of the [[disease]]
|
* [[Biopsy]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 3
! align="center" style="padding: 5px 5px; background: " |Motor disorders
| style="padding: 5px 5px; background: #F5F5F5;" |
([[Myasthenia gravis]])
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
|
| style="padding: 5px 5px; background: #F5F5F5;" |
* Gradual
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
| +
| +
|Progressive
|<nowiki>+/-</nowiki>
| -
|
* [[Ptosis]]
* [[Diplopia]]
* [[Fatigue]]
|Normal
|
* [[Stasis]] in [[pharynx]] and pooling in [[pharyngeal]] recesses
|
* [[Velopharyngeal insufficiency]]
* Delayed [[swallowing]] function
|
* [[CT-scans|CT]] may show anterior [[mediastinal]] mass ([[thymoma]])
* Positive tensilon test
|
* Anti–[[acetylcholine receptor]] [[antibody test]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 4
! align="center" style="padding: 5px 5px; background: " |[[GERD]]
| style="padding: 5px 5px; background: #F5F5F5;" |
|
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
* Gradual
| style="padding: 5px 5px; background: #F5F5F5;" |
 
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
* Sudden onset
|-
| +
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 5
| -
| style="padding: 5px 5px; background: #F5F5F5;" |
|Progressive
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| +/-
| style="padding: 5px 5px; background: #F5F5F5;" |
| +
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|
* [[Cough]]
 
* [[Hoarseness]]
|Normal
|
* Free [[acid reflux]]
* [[Esophagitis]] with [[scarring]]
* [[Strictures]]
* [[Barrett's oesophagus]]
|
* [[Erythema]], erosions and [[ulceration]]
* [[Barrett's esophagus]]
|
* [[Esophageal]] [[manometry]] may show decreased tone of [[Lower esophageal sphincter|LES]]
|
* 24 hour [[esophageal]] [[pH]] monitoring
|}
|}


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{{WS}}
{{WS}}
[[Category: (name of the system)]]
[[Category: (name of the system)]]
[[Category:Differential diagnosis]]

Latest revision as of 22:00, 7 February 2019

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

Overview

Barrett's esophagus must be differentiated from esophagitis, peptic ulcer disease, GERD, esophageal carcinoma and esophageal motor disorders.

Differentiating Barrett's Esophagus from other Diseases

Barrett's esophagus should be differentiated from the following diseases;

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 Normal
  • The esophageal lining appears pink or red and velvety. 
  • No any other test is done to diagnose Barrett's esophagus
Eosinophilic esophagitis Gradual + Progressive +/- +/- Normal
Esophageal carcinoma
  • Gradual
 + + Progressive + +/- Normal
Case courtesy of Dr Bruno Di Muzio, Radiopaedia.org, rID: 4232f
Motor disorders

(Myasthenia gravis)

  • Gradual
 + + Progressive +/- - Normal
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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