Cytokeratin immunoreactivity patterns in the diagnosis of short-segment Barrett's esophagus

Background & Aims: The origin of intestinal metaplasia in short segments of columnar mucosa at the esophagogastric junction has clinical importance bu t can be difficult to determine at endoscopy. Cytokeratin (CK) 7 and 20 pat terns are specific for long-segment Barrett's esophagus; however, their uti lity in short-segment Barrett's esophagus has not been assessed. Methods: E ndoscopic biopsy specimens from patients with long-segment Barrett's esopha gus (n = 49), suspected short-segment Barrett's esophagus (n = 43), and gas tric intestinal metaplasia (n = 26) were immunostained for CK7 and CK20. Co mprehensive clinical data were obtained, including age, gender, and hiatal hernia and Helicobacter pylori status. Results: A Barrett's CK7/20 pattern was present in 48 (98%) of 49 patients with long-segment Barrett's esophagu s, 35 (82%) of 43 with suspected short-segment Barrett's esophagus, and 0 ( 0%) of 26 patients with gastric intestinal metaplasia. Patients with suspec ted short-segment Barrett's esophagus with a Barrett's CK7/20 pattern were clinically similar to those with long-segment Barrett's esophagus. In contr ast, patients with suspected short-segment Barrett's esophagus with no Barr ett's CK7/20 pattern were clinically similar to those with gastric intestin al metaplasia. Conclusions: A Barrett's CK7/20 pattern identifies a subset of patients with suspected short-segment Barrett's esophagus who have a pat ient profile similar to that seen in long-segment Barrett's esophagus. A Ba rrett's CK7/20 pattern is an objective marker of Barrett's mucosa that in c onjunction with appropriate clinical and endoscopic data can be used by cli nicians to better define patients with short-segment Barrett's esophagus.