Differential Diagnosis for Suspected Barrett's Esophagus

When considering a diagnosis of Barrett's esophagus, it's crucial to evaluate the patient's symptoms and risk factors within the context of other potential esophageal and gastrointestinal conditions. The following differential diagnosis is organized into categories to guide clinical thinking:

• Single Most Likely Diagnosis

  • Gastroesophageal reflux disease (GERD): This is the most common condition associated with Barrett's esophagus. Chronic exposure of the esophageal mucosa to acidic gastric contents can lead to metaplastic changes characteristic of Barrett's esophagus. The presence of GERD symptoms such as heartburn and regurgitation, especially in obese individuals or those with a history of prolonged GERD, should raise suspicion for Barrett's esophagus.

• Other Likely Diagnoses

  • Eosinophilic esophagitis: This condition, characterized by an eosinophilic infiltration of the esophageal mucosa, often presents with dysphagia and food impaction, similar to symptoms that can be seen in advanced Barrett's esophagus or its complications.
  • Peptic stricture: Chronic GERD can also lead to the formation of peptic strictures, which may present with dysphagia, a symptom that can overlap with complications of Barrett's esophagus.

• Do Not Miss Diagnoses

  • Esophageal cancer: Although less common, esophageal cancer, particularly adenocarcinoma, is a critical diagnosis not to miss, as Barrett's esophagus is a precursor lesion. Any new onset of dysphagia, significant weight loss, or anemia in a patient with known or suspected Barrett's esophagus warrants immediate investigation for esophageal cancer.
  • Invasive fungal infections of the esophagus: In immunocompromised patients, fungal infections can mimic the symptoms of Barrett's esophagus or its complications and require prompt diagnosis and treatment to prevent severe outcomes.

• Rare Diagnoses

  • Zollinger-Ellison syndrome: A rare condition characterized by excessive gastric acid production due to a gastrin-secreting tumor, which can lead to severe GERD symptoms and potentially increase the risk for Barrett's esophagus.
  • Caustic esophagitis: Ingestion of caustic substances can lead to chronic esophageal damage and strictures, potentially mimicking some symptoms of Barrett's esophagus, although the history of caustic ingestion would typically distinguish this condition.