Cytokeratin 7 and 20 expression in intestinal metaplasia of the distal oesophagus: relationship to gastro‐oesophageal reflux disease

Abstract

CK7/20 immunoreactivity for patients with intestinal metaplasia of the distal oesophagus without long segment Barrett's oesophagus suggests a heterogeneous group, with an association between Barrett's CK7/20 pattern and gastro-oesophageal reflux disease in both short segment Barrett's and intestinal metaplasia of the gastro-oesophageal junction.

Immunoreactivity of cytokeratins 7 and 20 in goblet cells and columnar blue cells in patients with endoscopic evidence of Barrett's esophagus

“…The Barrett pattern was present in 94% of the specimens from esophageal resections and in 100% of the biopsies from patients with long-segment BE, and the gastric pattern was found in all of the biopsy specimens from the cardia and from gastric resections. Some subsequent studies appeared to reproduce these findings (19,25,30,31) . However, other authors presented discordant results and they concluded that these patterns are not useful to differentiate BE from intestinal metaplasia of the cardia (6,7,13,20,21,27) .…”

“…In spite of these inconsistencies, these studies produced some outcomes that deserve further consideration. SHEARER et al (31) mentioned that similar patterns of CK7/CK20 expression were frequently observed in adjacent areas with and without goblet cells. MOHAMMED et al (21) identified the Barrett pattern in 55% of biopsies from inflamed or normal cardiac mucosa without evidence of intestinal metaplasia.…”

“…One possible explanation is that these areas are in transformation towards an intestinal phenotype (2,19,31) BE is composed not only of goblet cells, but also of columnar blue cells, which may correspond to immature goblet cells (pregoblet cells), and AB-negative columnar cells (22) . The surface epithelium of the cardia can also contain AB-positive columnar cells (3,23) .…”

“…A previous study by ORMSBY et al (24) suggested that specific patterns of CK7/CK20 reactivity could help discriminate between Barrett's esophagus and intestinal metaplasia of the cardia. Other authors tried to reproduce these patterns, but obtained diverse results (6,7,12,13,19,20,21,25,27,30,31) . Until now, the expression of these cytokeratins has not been reported separately in the goblet cells and the columnar blue cells of individual cases, so it has been hard to evaluate whether the two cell types are similar or different in their expression of these proteins.…”

The Cytokeratins as Molecular Markers in Differential Diagnosis of Gastric Intestinal Metaplasia

“…However, a unique pattern of CK7 and CK20 immunohistochemical expression, designated the BM CK7/20 pattern, has been demonstrated to be both sensitive and specific to Barrett's oesphagus and may be used as an objective marker of Barrett's Metaplasia (BM) [11,12]. This pattern shows superficial CK20 staining and strong CK7 staining of both superficial and deep glands and can be used to distinguish BM from intestinal metaplasia of the stomach which, although can be histologically indistinguishable, has a different pattern of cytokeratin expression, is associated with Helicobacter pylori infection, and is not associated with an increased risk of malignancy [13,14]. However, the specificity of the cytokeratins were controversial and some recent studies have raised the question as to its specificity [10,14].…”