Distinction between short-segment Barrett's esophageal and cardiac intestinal metaplasia.
OBJECTIVE
To investigate the roles of mucin histochemistry, cytokeratin 7/20 (CK7/20) immunoreactivity, clinical characteristics and endoscopy to distinguish short-segment Barrett's esophageal (SSBE) from cardiac intestinal metaplasia (CIM).


METHODS
High iron diamine/Alcian blue (HID/AB) mucin-histochemical staining and immunohistochemical staining were used to classify intestinal metaplasia (IM) and to determine CK7/20 immunoreactivity pattern in SSBE and CIM, respectively, and these results were compared with endoscopical diagnosis and the positive rate of gastroesophageal reflux disease (GERD) symptoms and H pylori infection. Long-segment Barrett's esophageal and IM of gastric antrum were designed as control.


RESULTS
The prevalence of type III IM was significantly higher in SSBE than in CIM (63.33% vs 23.08%, P< 0.005). The CK7/20 immunoreactivity in SSBE showed mainly Barrett's pattern (76.66%), and the GERD symptoms in most cases which showed Barrett's pattern were positive, whereas H pylori infection was negative. However, the CK7/20 immunoreactivity in CIM was gastric pattern preponderantly (61.54%), but there were 23.08% cases that showed Barrett's pattern. H pylori infection in all cases which showed gastric pattern was significantly higher than those which showed Barrett's pattern (63.83% vs 19.30%, P< 0.005), whereas the GERD symptoms in gastric pattern were significantly lower than that in Barrett's pattern (21.28% vs 85.96%, P< 0.005).


CONCLUSIONS
Distinction of SSBE from CIM should not be based on a single method; however, the combination of clinical characteristics, histology, mucin histochemistry, CK7/20 immunoreactivity, and endoscopic biopsy should be applied. Type III IM, presence of GERD symptoms, and Barrett's CK7/20 immunoreactivity pattern may support the diagnosis of SSBE, whereas non-type III IM, positive H pylori infection, and gastric CK7/20 immunoreactivity pattern may imply CIM.
Liu
Gui-Sheng
GS
Department of Gastroenterology, Second Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China.
Gong
Jun
J
Cheng
Peng
P
Zhang
Jun
J
Chang
Ying
Y
Qiang
Lei
L
D001471:Barrett Esophagus / Q000473:pathology*; D002299:Cardia / Q000473:pathology*; D003937:Diagnosis, Differential; D004935:Esophageal Diseases / Q000473:pathology*; D004943:Esophagogastric Junction / Q000473:pathology; D005764:Gastroesophageal Reflux / Q000473:pathology; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000473:pathology; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000473:pathology; D006801:Humans; D007422:Intestines / Q000473:pathology*; D053554:Keratin-20; D053552:Keratin-7; D007633:Keratins / Q000378:metabolism; D008679:Metaplasia / Q000473:pathology*; D009077:Mucins / Q000378:metabolism
C507499:KRT20 protein, human; C507497:KRT7 protein, human; D053554:Keratin-20; D053552:Keratin-7; D009077:Mucins; D007633:Keratins