Document Detail


Cytokeratin immunoreactivity of intestinal metaplasia at normal oesophagogastric junction indicates its aetiology.
MedLine Citation:
PMID:  11709508     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 of Helicobacter 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 of H 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 pylori gastritis. 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.
Authors:
A Couvelard; J M Cauvin; D Goldfain; A Rotenberg; M Robaszkiewicz; J F Fléjou;
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Gut     Volume:  49     ISSN:  0017-5749     ISO Abbreviation:  Gut     Publication Date:  2001 Dec 
Date Detail:
Created Date:  2001-11-15     Completed Date:  2001-12-28     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  2985108R     Medline TA:  Gut     Country:  England    
Other Details:
Languages:  eng     Pagination:  761-6     Citation Subset:  AIM; IM    
Affiliation:
Service d'Anatomie Pathologique, Hôpital Beaujon, Clichy, France. anne.couvelard@bjn.ap-hop-paris.fr
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Barrett Esophagus / metabolism,  pathology
Biological Markers / analysis
Esophagogastric Junction / chemistry*,  pathology
Female
Gastritis / metabolism,  microbiology,  pathology
Gastroesophageal Reflux / complications,  metabolism,  pathology
Helicobacter Infections / metabolism,  pathology
Helicobacter pylori
Histocytochemistry
Humans
Immunohistochemistry
Intermediate Filament Proteins / analysis
Intestines / chemistry,  pathology*
Keratin-20
Keratin-7
Keratins / analysis*
Male
Metaplasia
Middle Aged
Prospective Studies
Statistics, Nonparametric
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Intermediate Filament Proteins; 0/KRT20 protein, human; 0/KRT7 protein, human; 0/Keratin-20; 0/Keratin-7; 68238-35-7/Keratins
Comments/Corrections
Comment In:
Gut. 2001 Dec;49(6):746-7   [PMID:  11709501 ]
Gut. 2002 Dec;51(6):894-5; author reply 895   [PMID:  12427798 ]

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