Barrett's oesophagus--radiological features in 100 cases.

The columnar-lined or Barrett's oesophagus is an acquired condition resulting from long-continued gastro-oesophageal reflux. In the last 20 years 149 patients with Barrett's oesophagus have been studied in the clinics of the Johannesburg Teaching Hospitals. Important radiological predictors of Barrett's oesophagus, as defined from a series of 100 cases, are the presence of a stricture well above the gastro-oesophageal junction (41 cases), a long stricture (13 cases) and ulceration in the body of the oesophagus (16 cases). An early stricture may be so subtle that it is missed or disregarded, and is the usual site of the squamocolumnar junction. Significant strictures may be seen even in the absence of a hiatus hernia. When associated with a hiatus hernia the strictures are usually concentric and are longer than the usual reflux strictures. The varying length of these strictures suggests an upward progression of the disease process, which begins at the gastro-oesophageal junction. This feature, seen in 6 of our patients, has not previously been stressed as a predictor for Barrett's oesophagus. Radiological reflux, although in itself a poor predictor, lends support to the diagnosis of Barrett's oesophagus if one or more of the other predictors is present. A less important predictor is a reticular mucosal pattern seen on double-contrast radiography.