Clinical evidence strongly suggests that bile acids are important in the development of Barrett’s esophagus, although the mechanism remains unknown. Caudal-related homeobox 2 (CDX2) is a transcription factor recently implicated in early differentiation and maintenance of normal intestinal epithelium and is suggested to play a key role in the pathogenesis of intestinal metaplasia in Barrett’s esophagus. The aim of this study was to investigate the effect of primary and secondary bile acids on CDX2 mRNA expression in human esophageal cells. METHODS: Human esophageal cells: 1) squamous, immortalized by SV40 (Het-1A), 2) adenocarcinoma (SEG-1), and 3) squamous cell carcinoma (HKESC-1 & HKESC-2), were exposed in tissue culture for 1-24 hours to 100-1000uM deoxycholic, chenodeoxycholic and glycocholic acid. Total RNA was extracted before and after bile acid treatment and reverse transcribed to cDNA. CDX2 mRNA expression was determined by both quantitative real time and reverse transcription PCR. RESULTS: CDX2 mRNA expression was absent before bile acid exposure in all cell lines. CDX2 expression increased in a dose and time dependent fashion with deoxycholic and chenodeoxycholic but not glycocholic acid in all four cell lines. The maximal induction of CDX2 expression was seen in SEG-1 adenocarcinoma cells (Figure, up to 1973-fold increases). Expression in Het-1A cells also increased significantly as did expression in HKESC-1,2 cells although to a lesser extent than in adenocarcinoma. CONCLUSIONS: These findings show that secondary bile acid stimulation upregulates CDX2 gene expression in both normal and cancer cell lines. They further support the role of bile acids in the pathogenesis of Barrett’s esophagus and link the clinical evidence of a high prevalence of luminal bile acids in Barrett’s to expression of the gene thought to be responsible for the phenotypic expression of intestinal metaplasia.