title: Cytokeratin immunoreactivity patterns in the diagnosis of short-segment Barrett's esophagus.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Anatomic Pathology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: A H
authors.initials: AH
authors.lastname: Ormsby
authors.forename: M F
authors.initials: MF
authors.lastname: Vaezi
authors.forename: J E
authors.initials: JE
authors.lastname: Richter
authors.forename: J R
authors.initials: JR
authors.lastname: Goldblum
authors.forename: T W
authors.initials: TW
authors.lastname: Rice
authors.forename: G W
authors.initials: GW
authors.lastname: Falk
authors.forename: T L
authors.initials: TL
authors.lastname: Gramlich
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis* / Q000378:metabolism* / Q000473:pathology; D015331:Cohort Studies; D004945:Esophagoscopy; D004947:Esophagus / Q000378:metabolism / Q000473:pathology; D005260:Female; D005753:Gastric Mucosa / Q000378:metabolism; D006801:Humans; D007158:Immunologic Techniques; D007381:Intermediate Filament Proteins / Q000378:metabolism*; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000473:pathology; D053554:Keratin-20; D053552:Keratin-7; D007633:Keratins / Q000378:metabolism*; D008297:Male; D008679:Metaplasia / Q000378:metabolism; D008875:Middle Aged; D009092:Mucous Membrane / Q000378:metabolism / Q000473:pathology; D015588:Observer Variation; D013270:Stomach / Q000473:pathology
chemical_list: D007381:Intermediate Filament Proteins; C507499:KRT20 protein, human; C507497:KRT7 protein, human; D053554:Keratin-20; D053552:Keratin-7; D007633:Keratins