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>
 
===Preferred Table===
 
{| class="wikitable"
{| class="wikitable"
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease
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| align="center" style="background:#4479BA; color: #FFFFFF;" |Type
| align="center" style="background:#4479BA; color: #FFFFFF;" |Type
|-
|-
|[[Barrett's esophagus]]
![[Barrett's esophagus]]
|Gradual
|Gradual
|
|
|
|
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|
|<nowiki>-</nowiki>
* Chest pain
|Progressive
|<nowiki>+/-</nowiki>
|<nowiki>+</nowiki>
|[[Gastroesophageal reflux disease|GERD]] [[Symptom|Symptoms]]
* [[Chest pain]]


* Chronic cough
* [[Chronic cough, severe cold|Chronic cough]]


* Laryngitis
* [[Laryngitis]]


* Regurgitation
* [[Regurgitation]]


* Heartburn
* [[Heartburn]]
|Normal
|Normal
|
|
* Mid or high [[esophageal ulcer]]
* Mid or high [[Esophageal stricture|esophageal web-like stricture]]
* Reticular mucosal pattern
|
|
* The [[esophageal]] lining appears pink or red and velvety. 
|
|
|Esophageal biopsy
* No any other test is done to diagnose Barrett's esophagus
|
* [[Esophageal]] [[Biopsy]]
|-
|-
|[[Eosinophilic esophagitis]]
![[Eosinophilic esophagitis]]
|Gradual
|Gradual
| +
| +
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|Normal
|Normal
|
|
* Multiple rings in the esophagus
* Multiple rings in the [[esophagus]]
|
|
* Concentric rings of the esophagus- Trachealization of the esophagus
* [[Concentric]] rings of the [[esophagus]]- Trachealization of the [[esophagus]]
|
|
* Increased serum IgE levels
* Increased [[IgE|serum IgE]] levels
|
|
* Esophageal biopsy
* [[Esophageal]] [[biopsy]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal carcinoma]]
! align="center" style="padding: 5px 5px; background: " |[[Esophageal carcinoma]]
|
|
* Gradual
* Gradual
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[[Image:Oesophageal-squamous-cell-carcinoma-2.jpg|center|200px|thumb|Case courtesy of Dr Bruno Di Muzio, Radiopaedia.org, rID: 4232f]]
[[Image:Oesophageal-squamous-cell-carcinoma-2.jpg|center|200px|thumb|Case courtesy of Dr Bruno Di Muzio, Radiopaedia.org, rID: 4232f]]
|
|
* [[Esophageal]] obstruction
* [[Esophageal]] [[obstruction]]
* Staging of disease
* [[Cancer staging|Staging]] of [[disease]]
<div style="width:350px">{{#ev:youtube|5ucSlgqGAno}}</div>
|
|
* [[CT]] and [[PET scan]] is an optional test for staging of the disease
* [[CT]] and [[PET scan]] is an optional test for [[Cancer staging|staging]] of the [[disease]]
|
|
* [[Biopsy]]
* [[Biopsy]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Motor disorders
! align="center" style="padding: 5px 5px; background: " |Motor disorders
([[Myasthenia gravis]])
([[Myasthenia gravis]])
|
|
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|Progressive
|Progressive
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|
| -
|
|
* [[Ptosis]]
* [[Ptosis]]
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|Normal
|Normal
|
|
* Stasis in [[pharynx]] and pooling in pharyngeal recesses
* [[Stasis]] in [[pharynx]] and pooling in [[pharyngeal]] recesses
|
|
* [[Velopharyngeal insufficiency]]
* [[Velopharyngeal insufficiency]]
* Delayed [[swallowing]] function
* Delayed [[swallowing]] function
|
|
* CT may show anterior [[mediastinal]] mass ([[thymoma]])  
* [[CT-scans|CT]] may show anterior [[mediastinal]] mass ([[thymoma]])  
* Positive tensilon test  
* Positive tensilon test  
|
|
* Anti–acetylcholine receptor antibody test
* Anti–[[acetylcholine receptor]] [[antibody test]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[GERD]]
! align="center" style="padding: 5px 5px; background: " |[[GERD]]
|
|
* Gradual
* Gradual
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|Normal
|Normal
|
|
* Free acid reflux
* Free [[acid reflux]]
* [[Esophagitis]] with scarring
* [[Esophagitis]] with [[scarring]]
* [[Strictures]]
* [[Strictures]]
* [[Barrett's oesophagus]]
* [[Barrett's oesophagus]]
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* [[Barrett's esophagus]]
* [[Barrett's esophagus]]
|
|
* Esophageal [[manometry]] may show decreased tone of [[Lower esophageal sphincter|LES]]
* [[Esophageal]] [[manometry]] may show decreased tone of [[Lower esophageal sphincter|LES]]
|
|
* 24 hour [[esophageal]] pH monitoring
* 24 hour [[esophageal]] [[pH]] monitoring
|}
 
===Use if the above table can not be made===
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Similar Features}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Differentiating Features}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 1
| 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].
| 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].
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 2
| 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].
| 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].
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 3
| 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].
| 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].
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 4
| 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].
| 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].
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 5
| 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].
| 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].
|}
|}


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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.

Template:WH Template:WS

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