Barrett’s esophagus is a metaplastic disorder in which specialized columnar epithelium replaces healthy squamous epithelium. Barrett’s metaplasia is the most common cause or precursor of esophageal carcinoma. The rate of esophageal adenocarcinoma is increasing in the Western world, and it is associated with a poor prognosis, mainly because individuals present with late-stage disease.
The preferred radiologic examination for Barrett’s esophagus is a double-contrast esophagography.
Imaging modalities that yield less information include nuclear medicine technetium-99m (99mTc) pertechnetate scanning, endoluminal ultrasonography, chromoendoscopy,
and computed tomography (CT) scanning. Of the newer technologies, inspection of the mucosa with high-resolution white light endoscopy is the most critical.
Positive findings on a double-contrast esophagogram suggest a diagnosis of Barrett’s esophagus, in correlation with the clinical history. However, an endoscopic examination with biopsy is required to confirm the diagnosis because columnar metaplasia is diagnosed at microscopy.
In addition, the features that suggest columnar metaplasia are not always present on the esophagogram. A Barrett stricture without the other features cannot be distinguished from the other etiologies of a stricture.
Radiologic characteristics of Barrett’s esophagus are presented in the images below.
Spot radiograph from double-contrast esophagography shows a smooth stricture in the midesophagus. Multiple ulcerations in the region of the stricture are seen. Note the reticular mucosal appearance extending down from the inferior aspect of the stricture.
Spot radiograph shows spontaneous severe gastroesophageal reflux extending upward beyond the Barrett stricture.
Barrett’s esophagus is named after Numan R. Barrett (1903-1979), a distinguished thoracic surgeon in London who in 1950 wrote an article entitled Chronic Peptic Ulcer of the Oesophagus and “Oesophagitis.” He concluded that most of the cases are examples of congenital short esophagus. He suggested that this was a separate entity from reflux esophagitis.
In Leeds, England, in 1953, Allison, a thoracic surgeon, and Johnstone, a radiologist, published an article entitled The Oesophagus Lined With Gastric Mucous Membrane. They suggested the term Barrett’s ulcers to describe ulcer craters in the columnar cell–lined esophagus. In 1957, Barrett published another article entitled The Lower Esophagus Lined by Columnar Epithelium, which he presented as a lecture at the Mayo Clinic. He now accepted the view of Allison and Johnstone that this condition involves a columnar cell–lined esophagus and not an extension of the stomach into the mediastinum. His conclusion that a columnar cell–lined esophagus is congenital was later disproved.