Barrett oesophagus

Case contributed by Dr Matt A. Morgan

Presentation

Long history of symptomatic gastro-oesophageal reflux, with heartburn and regurgitation.

Patient Data

Age: 55-60Y
Gender: Female
Barium

Images from a double-contrast oesophagram.

There is background granularity to the normal smooth-as-glass appearance of the oesophagus, compatible with reflux oesophagitis.

That's not all there is, though... at the gastro-oesophageal junction, there is a fine reticular pattern superimposed on the granularity. This pattern is concerning for Barrett oesophagus, which this turned out to be on EGD and biopsy.

Barium

Zoomed-in images of the fine reticular pattern superimposed on oesophagitis (fine granular pattern) found in Barrett oesophagus. The area of fine reticulation is either circled in red or pointed to with red arrows.

Thanks to Steve Rubesin MD for this case.

Case Discussion

Biopsy proven Barrett oesophagus (no histologic dysplasia). This is more than an incidental finding on an oesophagram -- this is a critical finding. By the time you find a lobulated esophageal carcinoma it's too late; the patient needs to be treated and followed at the first signs of metaplasia in the normal oesophageal stratified squamous epithelium.

It is important to get enough air/gas in the esophagus in order to optimize one's double contrast technique and pick up subtle findings like this. In addition to effervescent granules, it is often helpful to tell the patient to swallow as much air as possible while drinking the barium.

In this example, the Barrett oesophagus is at the gastro-oesophageal junction, but it can occur in patches anywhere from the mid-oesophagus down to the gastro-oesophageal junction.

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Case information

rID: 44421
Case created: 20th Apr 2016
Last edited: 4th Apr 2017
Inclusion in quiz mode: Included

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