Barium studies in patients with Barrett's esophagus: importance of focal areas of esophageal deformity.

Abstract

I report a subtle finding of columnar metaplasia of the esophagus (Barrett's esophagus) on barium examination that to my knowledge has not been described before. The finding is a focal mural deformity associated with fixed transverse folds and minimal limitation of distensibility of the esophagus at least 4 cm proximal to the esophagogastric junction. The abnormality was seen in four patients who had air-contrast upper gastrointestinal barium studies for evaluation of various gastrointestinal symptoms. Only one had symptoms referable to the esophagus. A diagnosis of Barrett's esophagus was suggested on the basis of the findings on barium studies and was confirmed by endoscopic biopsy. Initial radiographs showed subtle contour defects in the esophageal wall at least 4 cm proximal to the esophagogastric junction in each patient. These appeared as focal indentations (two cases) or a gradual concavity (two cases) in the wall that could be mistaken for a normal extrinsic impression or normal variation. Radiographs obtained with increased distension or in different degrees of obliquity showed fixed transverse folds suggestive of submucosal fibrosis. Barrett's esophagus was observed at endoscopy, but no endoscopic findings correlated with the focal changes seen on radiographs. Identification of focal defects in the esophageal contour at least 4 cm proximal to the esophagogastric junction on barium studies raises the possibility of Barrett's esophagus. The diagnosis is further suggested if repeat radiographs obtained with increased distension and different degrees of obliquity show fixed transverse folds, limited distensibility of the esophageal wall, or both.