The presence of a nonmalignant mid- or upper esophageal stricture always indicates the presence of:

B. Barrett's esophagus.

DISCUSSION: A stricture at or above the aortic arch is almost certainly situated above an esophagus lined at its lower end with columnar epithelium. Barrett's esophagus is suggested radiographically when local esophagitis, ulcer, or stricture is at the limits of a normal-looking segment of esophagus under the stricture but above a herniated stomach. The columnar-lined esophagus is not always associated with a high stricture; however Messiaen and Halpert documented strictures in 80% of their Barrett's patients. These high strictures, when seen with alkaline reflux esophagitis, with idiopathic reflux disease, or in association with scleroderma, always suggest the presence of a columnar-lined esophagus. Mediastinal fibrosis is a rare condition that can cause multilevel strictures on the esophagus.