Barrett esophagus: reticular pattern of the mucosa

Barrett esophagus is an acquired condition with progressive columnar metaplasia of the esophagus due to chronic reflux esophagitis. The premalignant nature of this entity is well recognized. However, radiologic diagnosis has been limited by the nonspecificity of findings associated with the condition. We recently reviewed 29 cases of pathologically proved Barrett esophagus. Radiologic examinations revealed hiatal hernias, gastroesophageal reflux, esophagitis, and strictures. None of these findings are diagnostic of Barrett esophagus. In seven cases, however, double-contrast radiography also revealed a delicate reticular pattern in the esophagus. In all but one case, there was an adjacent stricture, and this reticular appearance extended distally a short but variable distance from the stricture. To our knowledge, this unusual reticular pattern has not been described previously, and it represents a valuable radiologic sign of Barrett esophagus. The etiology of this finding is uncertain, but correlation with the gross surgical specimen in one case suggests that it results specifically from areas of "villous" metaplasia in Barrett epithelium. This delicate reticular pattern appears to be a specific radiologic criterion for the diagnosis of Barrett esophagus.