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==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
Barrett's esophagus must be differentiated from [[esophagitis]], [[peptic ulcer disease]], [[GERD]], [[esophageal carcinoma]] and esophageal motor disorders.


OR
==Differentiating Barrett's Esophagus from other Diseases==
Barrett's esophagus should be differentiated from the following diseases;
*[[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>
** Pill [[esophagitis]]
** [[Eosinophilic esophagitis]]
** Infectious esophagitis


[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
*[[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]]
* 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]]


==Differentiating X from other Diseases==
* [[Chronic cough, severe cold|Chronic cough]]
*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
*[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].


*As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].
* [[Laryngitis]]
==Differentiating Barrett's Esophagus from other Diseases==
*[[Esophagitis]]
# [[pill esophagitis]]
# [[eosinophilic 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>
*[[GERD]]<ref>http://www.wrongdiagnosis.com/b/barretts_esophagus/misdiag.htm</ref>
* [[Peptic ulcer disease]]
* [[Esophageal motor disorders]]


* [[Regurgitation]]


===Preferred Table===
* [[Heartburn]]
{|
|Normal
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
|
! rowspan="2" |Diseases
* Mid or high [[esophageal ulcer]]
! colspan="4" |Laboratory Findings
* Mid or high [[Esophageal stricture|esophageal web-like stricture]]
! colspan="4" |Physical Examination
* Reticular mucosal pattern
! colspan="4" |History and Symptoms
|
! rowspan="2" |Other Findings
* The [[esophageal]] lining appears pink or red and velvety. 
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
|
!Lab Test 1
* No any other test is done to diagnose Barrett's esophagus
!Lab Test 2
|
!Lab Test 3
* [[Esophageal]] [[Biopsy]]
!Lab Test 4
!Physical Finding 1
!Physical Finding 2
!Physical Finding 3
!Physical Finding 4
!Finding 1
!Finding 2
!Finding 3
!Finding 4
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 1
![[Eosinophilic esophagitis]]
|style="background: #F5F5F5; padding: 5px;" |
|Gradual
|style="background: #F5F5F5; padding: 5px;" |
| +
|style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
|
|style="background: #F5F5F5; padding: 5px;" |
|Progressive
|style="background: #F5F5F5; padding: 5px;" |
| +/-
|style="background: #F5F5F5; padding: 5px;" |
| +/-
|style="background: #F5F5F5; padding: 5px;" |
|
|style="background: #F5F5F5; padding: 5px;" |
* [[Chest pain]]
| style="background: #F5F5F5; padding: 5px;" |
* Food impaction
|style="background: #F5F5F5; padding: 5px;" |
* [[Cough]]
|style="background: #F5F5F5; padding: 5px;" |
|Normal
|style="background: #F5F5F5; padding: 5px;" |
|
|style="background: #F5F5F5; padding: 5px;" |
* Multiple rings in the [[esophagus]]
|
* [[Concentric]] rings of the [[esophagus]]- Trachealization of the [[esophagus]]
|
* Increased [[IgE|serum IgE]] levels
|
* [[Esophageal]] [[biopsy]]
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 2
! align="center" style="padding: 5px 5px; background: " |[[Esophageal carcinoma]]
|style="background: #F5F5F5; padding: 5px;" |'''↑'''
|
|style="background: #F5F5F5; padding: 5px;" |
* Gradual
|style="background: #F5F5F5; padding: 5px;" |
|<nowiki>+</nowiki>
|style="background: #F5F5F5; padding: 5px;" |-
|<nowiki>+</nowiki>
|style="background: #F5F5F5; padding: 5px;" |
|Progressive
|style="background: #F5F5F5; padding: 5px;" |
| +
|style="background: #F5F5F5; padding: 5px;" |
|<nowiki>+/-</nowiki>
|style="background: #F5F5F5; padding: 5px;" |
|
|style="background: #F5F5F5; padding: 5px;" |
* [[Lymphadenopathy]]
| style="background: #F5F5F5; padding: 5px;" |
 
|style="background: #F5F5F5; padding: 5px;" |
* [[Cachexia]]
|style="background: #F5F5F5; padding: 5px;" |
|Normal
|style="background: #F5F5F5; padding: 5px;" |
|
* 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="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 3
! align="center" style="padding: 5px 5px; background: " |Motor disorders
|style="background: #F5F5F5; padding: 5px;" |
([[Myasthenia gravis]])
|style="background: #F5F5F5; padding: 5px;" |↓
|
|style="background: #F5F5F5; padding: 5px;" |
* Gradual
|style="background: #F5F5F5; padding: 5px;" |
| +
|style="background: #F5F5F5; padding: 5px;" |
| +
|style="background: #F5F5F5; padding: 5px;" |
|Progressive
|style="background: #F5F5F5; padding: 5px;" |
|<nowiki>+/-</nowiki>
|style="background: #F5F5F5; padding: 5px;" |
| -
|style="background: #F5F5F5; padding: 5px;" |
|
|style="background: #F5F5F5; padding: 5px;" |
* [[Ptosis]]
|style="background: #F5F5F5; padding: 5px;" |
* [[Diplopia]]
|style="background: #F5F5F5; padding: 5px;" |
* [[Fatigue]]
|style="background: #F5F5F5; padding: 5px;" |
|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="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4
! align="center" style="padding: 5px 5px; background: " |[[GERD]]
|style="background: #F5F5F5; padding: 5px;" |
|
|style="background: #F5F5F5; padding: 5px;" |
* Gradual
|style="background: #F5F5F5; padding: 5px;" |
 
|style="background: #F5F5F5; padding: 5px;" |
* Sudden onset
|style="background: #F5F5F5; padding: 5px;" |
| +
|style="background: #F5F5F5; padding: 5px;" |
| -
|style="background: #F5F5F5; padding: 5px;" |
|Progressive
|style="background: #F5F5F5; padding: 5px;" |
| +/-
|style="background: #F5F5F5; padding: 5px;" |
| +
|style="background: #F5F5F5; padding: 5px;" |
|
|style="background: #F5F5F5; padding: 5px;" |
* [[Cough]]
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|}


===Use if the above table can not be made===
* [[Hoarseness]]
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align=center
|Normal
|valign=top|
|
|+
* Free [[acid reflux]]
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
* [[Esophagitis]] with [[scarring]]
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Similar Features}}
* [[Strictures]]
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Differentiating Features}}
* [[Barrett's oesophagus]]
|-
|
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|Differential 1
* [[Erythema]], erosions and [[ulceration]]
| style="padding: 5px 5px; background: #F5F5F5;"|
* [[Barrett's esophagus]]
* 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;"|
* [[Esophageal]] [[manometry]] may show decreased tone of [[Lower esophageal sphincter|LES]]
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|
|-
* 24 hour [[esophageal]] [[pH]] monitoring
| 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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