Cytokeratin immunoreactivity of intestinal metaplasia at normal oesophagogastric junction indicates its aetiology

BACKGROUND AND AIMS Cytokeratin (CK) 7 and 20 patterns are specific for long and short segments of Barrett9s 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 Barrett9s and the other with characteristics of Helicobacter pylori gastritis. The Barrett9s type CK7/CK20 pattern was related to a high frequency of gastro-oesophageal reflux symptoms (p H pylori infection (p 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 Barrett9s 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 Barrett9s oesophagus and thus cancer.