Barrett's metaplasia is recognized by specialized columnar epithelium on the distal esophagus.
However, the events involved in the transformation from squamous to Barrett's epithelium remain unclear.
In this study, published in the December issue of Diseases of the Esophagus, researchers describe the characteristics observed during the recurrence of 4 cases of columnar-lined esophagus.
The team observed the development of red velvet, gastric-like, esophageal mucosa above the anastomosis during follow-up of 4 patients.
Patients had been submitted to surgery for esophageal and junctional adenocarcinoma.
|Areas of recurrence were associated with reflux symptoms and inflammation.|
|Diseases of the Esophagus|
These areas of recurrence were associated with reflux symptoms and inflammation, and with ulceration in 2 cases.
The team examined biopsies from upper GI endoscopies using periodic acid-Schiff/Alcian blue to detect acid mucins, and a monoclonal antibody raised against the enterocytic enzyme sucrase-isomaltase.
In all cases the recurrent columnar-lined segments displayed intestinal features recognized morphologically, histochemically, and/or immunohistochemically.
Researchers found no evidence of specialized columnar epithelium in 3 cases.
The fourth patient developed specialized columnar epithelium during the tenth year of surveillance.
The team determined that the presence of AB-positive columnar cells was a frequent and early event.
However, columnar cells with unequivocal apical sucrase-isomaltase were observed only in association with specialized columnar epithelium.
Dr Chaves's team concluded, "That the development of columnar-lined mucosa without specialized columnar epithelium may be the earliest event in Barrett's metaplasia".
That the "histochemistry is a useful method of recognizing a population with cryptic intestinal features"
In addition "Acid mucin secretion precedes the production of enterocytic enzymes by columnar cells".
"And that a cell population with enterocytic differentiation, as assessed by sucrase-isomaltase expression, is associated with the development of specialized columnar epithelium".
"These characteristics of Barrett's esophagus development are clinically relevant as they suggest that patients with columnar-lined esophagus without specialized columnar epithelium may acquire 'true' intestinal phenotype, justifying them being considered as high-risk patients".