Liu Gui-Sheng, Gong Jun, Cheng Peng, Zhang Jun, Chang Ying, Qiang Lei
Department of Gastroenterology, Second Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China.
World J Gastroenterol. 2005 Oct 28;11(40):6360-5. doi: 10.3748/wjg.v11.i40.6360.
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).
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.
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).
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.
探讨黏蛋白组织化学、细胞角蛋白7/20（CK7/20）免疫反应性、临床特征及内镜检查在区分短节段Barrett食管（SSBE）和贲门肠化生（CIM）中的作用。
采用高铁二胺/阿尔辛蓝（HID/AB）黏蛋白组织化学染色和免疫组织化学染色分别对肠化生（IM）进行分类，并确定SSBE和CIM中CK7/20的免疫反应性模式，将这些结果与内镜诊断以及胃食管反流病（GERD）症状和幽门螺杆菌感染的阳性率进行比较。以长节段Barrett食管和胃窦IM作为对照。
SSBE中III型IM的患病率显著高于CIM（63.33%对23.08%，P<0.005）。SSBE中CK7/20免疫反应性主要表现为Barrett模式（76.66%），大多数表现为Barrett模式的病例中GERD症状呈阳性，而幽门螺杆菌感染呈阴性。然而，CIM中CK7/20免疫反应性主要为胃型（61.54%），但有23.08%的病例表现为Barrett模式。所有表现为胃型的病例中幽门螺杆菌感染显著高于表现为Barrett模式的病例（63.83%对19.30%，P<0.005），而胃型中的GERD症状显著低于Barrett模式（21.28%对85.96%，P<0.005）。
区分SSBE和CIM不应仅基于单一方法；然而，应综合应用临床特征、组织学、黏蛋白组织化学、CK7/20免疫反应性和内镜活检。III型IM、GERD症状的存在以及Barrett型CK7/20免疫反应性模式可能支持SSBE的诊断，而非III型IM、幽门螺杆菌感染阳性和胃型CK7/20免疫反应性模式可能提示CIM。
