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HID-AB mucin histochemical analysis in goblet and non-goblet Barrett esophagitis

The syndrome of peptic ulceration of the esophagus arising in the gastric type epithelium associated with an esophageal stricture described by Barrett in 1950 was considered, incorrectly, to be due to congenitally short esophagus. Since then, the syndrome has been called Barrett's esophagus ; however, replacement of squamous epithelium by columnar epithelium, resembling gastric or intestinal mucosa, has been described later, mostly due to reflux esophagitis. Recently published studies that used various mucin histochemical stains in observed specimens to identify neutral mucins and acid mucins (sialomucins and sulfomucins) indicate that the intestinal type does not necessarily resemble normal small intestine. It is presumed that the diagnosis of Barrett's esophagus is not forced only by histologic findings of goblet cells but also of acid mucin-positive non-goblet columnar cells (NGCC) in the surface epithelium of biopsy specimens. However, the significance of the acid mucin-positive NGCC finding in the surface epithelium from the distal esophagus/gastroesophageal junction (GEJ) in the absence of goblet cells (GC) remains unknown. The aim of the study was to assess the prevalence of sulfomucins in endoscopic biopsies of patients with a columnar lined (Barrett's) esophagus. We compared histopathologic features of biopsy specimens in the surface, foveolar and glandular epithelium taken from the distal esophagus/GEJ diagnosed as Barrett's esophagus in the presence of special columnar epithelium with and without goblet cells. We randomly selected biopsy specimens of 33 patients from our database from the 2000-2008 period. The specimens were stained with alcian blue/periodic acid-Schiff stain (AB- PAS) and high-iron diamine/alcian blue (HID-AB) dividing results into two groups: Barrett's esophagitis with and without GC. Out of 33 stained specimens, 21 were of special columnar intestinal metaplastic (IM) type (type I = 0, type II = 10, type III = 11) with 9:12 male/female ratio, and 12 were NGCC (type I = 0, type II = 7, type III = 5) with 8:4 male/female ratio. In the GC and NGCC group, acid-mucin (sulfomucin)-positive cells were detected in 11 (52%) and 5 (42%) cases, respectively. In the lack of classic special columnar epithelium (with goblet cells) in the esophagus, the presence of metaplastic junctional type of mucosa may quite probably be considered as an initial step towards transformation to the classic Barrett's mucosa, most of all because of the definition of Barrett as a precancerous condition for esophageal adenocarcinoma. As Barrett's esophagus is a precancerous lesion, additional research is needed to evaluate whether the neoplastic progression is related to its mucin profile or the detection of acid-mucin (sulfomucin)-positive non-goblet cells is an early form of intestinal metaplasia, thus deserving attention and follow up.

histochemical analysis; Barrett esophagitis

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