The radiologic diagnosis of Barrett esophagus: Importance of mucosal surface abnormalities on air-contrast barium studies

Patients with Barrett esophagus are predisposed to the development of esophageal adenocarcinoma. Identification of these patients before this complication develops is essential. We prospectively made the diagnosis of Barrett esophagus on routine biphasic upper gastrointestinal series in nine patients in whom a mucosal surface pattern alteration was the only radiologic abnormality on the esophagogram. The diagnosis was confirmed by biopsy in eight patients and during surgery in one patient. Only a third of the patients had symptoms related to the esophagus. Two types of surface changes were noted. A reticular pattern was present in six cases and a villous pattern in five cases. Both patterns were noted in two patients. This series was obtained in a 5-year interval during which there were 15 additional patients with Barrett esophagus and corresponding esophagograms. None of these patients had normal results on esophagograms. Recognition of these subtle surface patterns, particularly in the absence of other reflux-induced abnormalities, may improve detection of Barrett esophagus and aid in the selection of patients for subsequent surveillance.