The Expression Patterns And Significance Of Cytokeratins On Barrett's Esophagus And Cardia Metaplasia

[Background and Objective]Barrett's esophagus(BE) is an important precancerous disease. There are still debates for facts such as its definition ,diagnosis et al on BE.A new Hainan consensus of our country in 2006 on gastroesophageal reflux disease(GERD) will impel to the research on BE. Firstly,we investigated endoscopic screening and pathological characteristics of Barrett's esophagus by the new consensus to know if there are difference s compared with the previous similar research. Secondly, although differentiating SSBE from cardia metaplasia(CIM)is usually difficult with their adjacent anatomic location, similar histological characteristics, the accurate diagnosis is very important for their apparent difference in treatment protocols and risk of malignagcy between them. We try to determine the role of cytokeratin 7/20 (CK7/20) immunoreactivity, mucin histochemistry, clinical characteristics and endoscopy to distinguish short-segment Barrett's esophageal (SSBE) from cardiac intestinal metaplasia (CIM).[Materials and Methods]1.Forty-four cases of Barrett's esophagus identified both by endoscope and pathology were enrolled in this study. The age distribution,sex distinction,endoscopic manifestation, pathological changes and syndrome were analysed.2.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]1.Forty-four cases were diagnosed for Barrett's esophagus by both endoscope and pathology .The incidence f BE was 0.59% in 7938 cases receiving endoscope. There were no differences in sex distinction (P>0.05) .The island pattern was the most prominent type accounting for 59% in the BE. The ring pattern and the tongue pattern were respectively 18%, 23%. There were differences in incidences among all types of BE (P<0.05) .The apparent statistics difference of the incidence of intestinal metaplasia were found between LSBE and SSBE (P value =0.0001) . The rate of the specialized intestinal metaplasia and rate of incidence of reflux esophagitis in the ring pattern were highest in them.2.The prevalence of type III IM was significantly higher in SSBE than in CIM (66.7% vs 27.3%, P<0.05). The CK7/20 immunoreactivity in SSBE showed mainly Barrett's pattern (72.2%), and the GERD symptoms in most cases which showed Barrett's pattern were positive. GERD symptoms in gastric pattern were significantly lower than that in Barrett's pattern (14.6% vs 88.9%, P<0.05).The CK7/20 immunoreactivity in CIM was gastric pattern preponderantly (68.1%), but there were 27.3% cases that showed Barrett's pattern. There were no statistical difference for the incidence of H pylori infection which were almost same high in all groups.[Conclusion]1.SSBE is the most prominent type accounting for 90.9% in the BE.We should pay attention to the endoscopic manifestatiaon of all types of SSBE when undergoing endoscopy.With high incidence of the specialized intestinal metaplasia which can predict more risk suffering adenocarcinoma in LSBE and the BE of ring pattern ,the regular surveillance of undergoing endoscopy and pathology should be adopted for them.2.Though a few useful parameters including the type of IM ,CK7/20 immune expression patterns and GERD symptoms ,distinction of SSBE from CIM should not be based on a single method; The combination of mucin histochemistry, CK7/20 immunoreactivity, and endoscopic biopsy should be applied. Type III IM and Barrett's CK7/20 immunoreactivity pattern may support the diagnosis of SSBE, whereas non-typeIII IM and gastric CK7/20 immunoreactivity pattern may imply CIM.