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
Line 38: Line 38:
| align="center" style="background:#4479BA; color: #FFFFFF;" |Type
| align="center" style="background:#4479BA; color: #FFFFFF;" |Type
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Esophageal carcinoma]]
![[Barrett's esophagus]]
|
|Gradual
* Gradual
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|Progressive
|Progressive
| +
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|
|<nowiki>+</nowiki>
* [[Lymphadenopathy]]
|[[Gastroesophageal reflux disease|GERD]] [[Symptom|Symptoms]]
* [[Chest pain]]
 
* [[Chronic cough, severe cold|Chronic cough]]
 
* [[Laryngitis]]
 
* [[Regurgitation]]


* [[Cachexia]]
* [[Heartburn]]
|Normal
|Normal
|
|
* Irregular [[Strictures|stricture]]
* Mid or high [[esophageal ulcer]]
* Pre-stricture [[dilatation]]
* Mid or high [[Esophageal stricture|esophageal web-like stricture]]
[[Image:Oesophageal-squamous-cell-carcinoma-2.jpg|center|200px|thumb|Case courtesy of Dr Bruno Di Muzio, Radiopaedia.org, rID: 4232f]]
* Reticular mucosal pattern
|
|
* [[Esophageal]] obstruction
* The [[esophageal]] lining appears pink or red and velvety. 
* Staging of disease
<div style="width:350px">{{#ev:youtube|5ucSlgqGAno}}</div>
|
|
* [[CT]] and [[PET scan]] is an optional test for staging of the disease
* No any other test is done to diagnose Barrett's esophagus
|
|
* [[Biopsy]]
* [[Esophageal]] [[Biopsy]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Systemic sclerosis]]
![[Eosinophilic esophagitis]]
|Gradual
| +
|
|
* Gradual
| +
|<nowiki>+</nowiki>
|Progressive
|Progressive
| +/-
| +/-
| +
| +/-
|
|
* [[Muscle pain|Muscle]] and [[Arthralgia|joint pain]]
* [[Chest pain]]
 
* Food impaction
* [[Raynaud's phenomenon]]
* [[Cough]]
 
* [[Skin changes]]  
|Normal
|Normal
|
|
* Dysmotility
* Multiple rings in the [[esophagus]]
 
|
* Patulous [[esophagus]]
* [[Concentric]] rings of the [[esophagus]]- Trachealization of the [[esophagus]]
|
|
* [[Mucosal]] damage
* Increased [[IgE|serum IgE]] levels
 
* [[Peptic]] stricture (advanced cases)
|Positive serology for
* [[Antinuclear antibodies]]
 
* [[Rheumatoid factor]]
 
* [[Creatine kinase]]
 
* [[ESR]]
|
|
* [[Skin biopsy]]
* [[Esophageal]] [[biopsy]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Stroke]]
! align="center" style="padding: 5px 5px; background: " |[[Esophageal carcinoma]]
([[Cerebral hemorrhage]])
|
|
* Sudden
* Gradual
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|Progressive
|Progressive
|<nowiki>+</nowiki>
| +
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|
|
* [[Dysarthria]]
* [[Lymphadenopathy]]


* Limb [[weakness]]
* [[Cachexia]]
 
|Normal
* [[Fatigue]]
|Impaired
|
|
* Pooling of [[Contrast medium|contrast]] in the [[pharynx]]
* Irregular [[Strictures|stricture]]
* [[Aspiration]] of [[barium]] [[Contrast medium|contrast]] into the [[airway]]
* Pre-stricture [[dilatation]]
[[Image:Oesophageal-squamous-cell-carcinoma-2.jpg|center|200px|thumb|Case courtesy of Dr Bruno Di Muzio, Radiopaedia.org, rID: 4232f]]
|
|
* Reduced opening of [[upper esophageal sphincter]]
* [[Esophageal]] [[obstruction]]
* Reduced [[larynx]] elevation
* [[Cancer staging|Staging]] of [[disease]]
|
|
* [[CT]] without [[contrast]] shows acute [[hemorrhage]] as a hyperattenuating [[clot]]
* [[CT]] and [[PET scan]] is an optional test for [[Cancer staging|staging]] of the [[disease]]
|
|
* [[CT]] without [[Contrast medium|contrast]]
* [[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]]
Line 140: Line 128:
|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]]
Line 174: Line 162:
* [[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.

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