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Cytokeratin immunoreactivity of intestinal metaplasia at normal oesophagogastric junction indicates its aetiology
  1. A Couvelarda,
  2. J-M Cauvinb,
  3. D Goldfainc,
  4. A Rotenbergc,
  5. M Robaszkiewiczd,
  6. J-F Fléjou members of the Groupe d'Etude de l'Oesophage de Barrette
  1. aService d'Anatomie Pathologique, Hôpital Beaujon, Clichy, France, bDépartement d'Information Médicale, CHU Brest, France, cService de Gastroentérologie, CHG, Dreux, France, dService de Gastroentérologie, CHU Brest, France, eService d'Anatomie Pathologique, Hôpital Saint-Antoine, Paris, France
  1. Dr A Couvelard, Service d'Anatomie Pathologique, Hôpital Beaujon, F-92118, Clichy cedex, France.anne.couvelard{at}bjn.ap-hop-paris.fr

Abstract

BACKGROUND AND AIMS Cytokeratin (CK) 7 and 20 patterns are specific for long and short segments of Barrett's oesophagus but their use has not been assessed in intestinal metaplasia arising in macroscopically normal gastro-oesophageal junction (GOJ).

PATIENTS AND METHODS This study was carried out in a large prospective series of 254 patients who underwent upper endoscopy, had normal gastro-oesophageal anatomy, and who had biopsies of the antrum, fundus, cardia, GOJ, and lower oesophagus. Intestinal metaplasia of the GOJ was typed by histochemistry with high iron diamine-alcian blue staining and by immunohistochemistry using CK7 and CK20 antibodies. Results were correlated with clinical, endoscopic, and pathological data.

RESULTS Sixty (23.6%) of our patients presenting with a normal GOJ had intestinal metaplasia. The CK7/CK20 pattern identified two groups of patients: one highly correlated with Barrett's and the other with characteristics ofHelicobacter pylori gastritis. The Barrett's type CK7/CK20 pattern was related to a high frequency of gastro-oesophageal reflux symptoms (p<0.02) and normal endoscopic appearance of the stomach (p<0.03). In contrast, the gastric type CK7/CK20 pattern was linked to atrophic (p<0.02) or erythematous (p<0.05) appearance of the stomach (p<0.03), high frequency ofH pylori infection (p<0.04), antral inflammation (p<0.006) with atrophy (p<0.02), and intestinal metaplasia (p<0.02).

CONCLUSION In patients presenting with intestinal metaplasia in normal appearing GOJ, the cytokeratin pattern identifies two groups of patients, one with features identical to those of long segment Barrett's oesophagus and one with features seen in H pylorigastritis. These data may be used by clinicians and should result in improved endoscopic surveillance strategies targeted specifically at patients at increased risk of Barrett's oesophagus and thus cancer.

  • Barrett's oesophagus
  • cardia
  • intestinal metaplasia
  • cytokeratins
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Footnotes

  • * Members of the GEOB are listed in the .

  • Abbreviations used in this paper:
    CK
    cytokeratin
    GOJ
    gastro-oesophageal junction
    GORD
    gastro-oesophageal reflux disease
    AB-HID
    Alcian blue-high iron diamine

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