Cytokeratin immunoreactivity patterns in the diagnosis of short-segment Barrett's esophagus

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 119; no. 3; pp. 683 - 690
• Main Authors: Ormsby, Adrian H., Vaezi, Michael F., Richter, Joel E., Goldblum, John R., Rice, Thomas W., Falk, Gary W., Gramlich, Terry L.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-09-2000; Elsevier
• Subjects: Aged; Barrett Esophagus - diagnosis; Barrett Esophagus - metabolism; Barrett Esophagus - pathology; Biological and medical sciences; Cohort Studies; Digestive system; Esophagoscopy; Esophagus - metabolism; Esophagus - pathology; Female; Gastric Mucosa - metabolism; Humans; Immunologic Techniques; Intermediate Filament Proteins - metabolism; Intestinal Mucosa - metabolism; Intestines - pathology; Investigative techniques, diagnostic techniques (general aspects); Keratin-20; Keratin-7; Keratins - metabolism; Male; Medical sciences; Metaplasia - metabolism; Middle Aged; Mucous Membrane - metabolism; Mucous Membrane - pathology; Observer Variation; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Stomach - pathology; CK7/20; PAS; Human; Immunohistochemistry; Cytokeratin; Esophageal disease; Barrett esophagus; Protein; Pathology; Immunoreactive form; Sociodemographic factor; Cohort study; Intestinal metaplasia; Digestive diseases; Intestinal disease; Diagnosis; Comparative study
• ISSN: 0016-5085; 1528-0012
• DOI: 10.1053/gast.2000.16482

Background & Aims: The origin of intestinal metaplasia in short segments of columnar mucosa at the esophagogastric junction has clinical importance but can be difficult to determine at endoscopy. Cytokeratin (CK) 7 and 20 patterns are specific for long-segment Barrett's esophagus; however, their utility in short-segment Barrett's esophagus has not been assessed. Methods: Endoscopic biopsy specimens from patients with long-segment Barrett's esophagus (n = 49), suspected short-segment Barrett's esophagus (n = 43), and gastric intestinal metaplasia (n = 26) were immunostained for CK7 and CK20. Comprehensive clinical data were obtained, including age, gender, and hiatal hernia and Helicobacter pylori status. Results: A Barrett's CK7/20 pattern was present in 48 (98%) of 49 patients with long-segment Barrett's esophagus, 35 (82%) of 43 with suspected short-segment Barrett's esophagus, and 0 (0%) of 26 patients with gastric intestinal metaplasia. Patients with suspected short-segment Barrett's esophagus with a Barrett's CK7/20 pattern were clinically similar to those with long-segment Barrett's esophagus. In contrast, patients with suspected short-segment Barrett's esophagus with no Barrett's CK7/20 pattern were clinically similar to those with gastric intestinal metaplasia. Conclusions: A Barrett's CK7/20 pattern identifies a subset of patients with suspected short-segment Barrett's esophagus who have a patient profile similar to that seen in long-segment Barrett's esophagus. A Barrett's CK7/20 pattern is an objective marker of Barrett's mucosa that in conjunction with appropriate clinical and endoscopic data can be used by clinicians to better define patients with short-segment Barrett's esophagus.
GASTROENTEROLOGY 2000;119:683-690