Clinical Research
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2005; 11(40): 6360-6365
Published online Oct 28, 2005. doi: 10.3748/wjg.v11.i40.6360
Distinction between short-segment Barrett’s esophageal and cardiac intestinal metaplasia
Gui-Sheng Liu, Jun Gong, Peng Cheng, Jun Zhang, Ying Chang, Lei Qiang
Gui-Sheng Liu, Jun Gong, Peng Cheng, Jun Zhang, Ying Chang, Department of Gastroenterology, the Second Hospital of Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
Lei Qiang, Department of Pathology, the Second Hospital of Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
Author contributions: All authors contributed equally to the work.
Supported by the grant from Clinical Key Project of the Healthy Congress, No. 20012130
Correspondence to: Dr. Jun Gong, Department of Gastroenterology, the Second Hospital of Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China. gongxiaoyishan@sina.com
Telephone: +86-29-88083495
Received: December 23, 2004
Revised: March 13, 2005
Accepted: March 16, 2005
Published online: October 28, 2005
Abstract

AIM: 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).

CONCLUSION: 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.

Keywords: Short-segment Barrett’s esophageal, Cardiac intestinal metaplasia, Cytokeratin 7/20 immunoreactivity