Human Pathology
Volume 41, Issue 2 , Pages 223-231, February 2010

Development of consensus guidelines for the histologic recognition of microscopic esophagitis in patients with gastroesophageal reflux disease: the Esohisto project☆☆☆

  • Roberto Fiocca, MD

      Affiliations

    • Department of Anatomic Pathology, University of Genoa, Genoa, Italy
    • Corresponding Author InformationCorresponding author. Division of Anatomical Pathology, University of Genoa, Via De Toni 14, 16132 Genoa, Italy.
    • ,
  • Luca Mastracci, MD

      Affiliations

    • Department of Anatomic Pathology, University of Genoa, Genoa, Italy
    • ,
  • Robert Riddell, MD

      Affiliations

    • Department of Pathology, Mount Sinai Hospital, Toronto, Canada
    • ,
  • Kaiyo Takubo, MD

      Affiliations

    • Department of Clinical Pathology, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
    • ,
  • Michael Vieth, MD

      Affiliations

    • Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany
    • ,
  • Lisa Yerian, MD

      Affiliations

    • Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH
    • ,
  • Prateek Sharma, MD

      Affiliations

    • Division of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, KS, USA
    • ,
  • Paula Fernström, MSc

      Affiliations

    • AstraZeneca R&D, Mölndal, Sweden
    • ,
  • Magnus Ruth, MD

      Affiliations

    • AstraZeneca R&D, Mölndal, Sweden

Received 26 March 2009; received in revised form 18 July 2009; accepted 23 July 2009. published online 05 October 2009.

Summary 

No gold standard test exists for gastroesophageal reflux disease (GERD). Diagnostic difficulties are greatest when reflux symptoms occur without visible esophageal mucosal damage at conventional endoscopy. However, two thirds of such patients do have microscopic esophageal lesions. This study aimed to develop and standardize criteria for recognizing these microscopic esophageal lesions in GERD. Draft histologic criteria were developed and tested by an international group of 5 independent gastrointestinal pathologists using 167 biopsy specimens from GERD patients and healthy controls (phase I). Draft criteria were refined and reassessed using 250 photographs of biopsy specimens (phase II). Histologic lesions evaluated were basal cell hyperplasia, papillary elongation, intraepithelial eosinophil, neutrophil and mononuclear cell number, necrosis/erosion, healed erosion, and dilated intercellular spaces. Interobserver agreement and κ values increased significantly from phase I to II. When tested in annotated photographs (phase II), mean pairwise agreements were 74%, 89%, 93%, 97%, 81%, 97%, 94%, and 74%, respectively. Mean pairwise κ estimates (±SD) were 0.49 (0.16), 0.81 (0.05), 0.87 (0.05), 0.84 (0.09), 0.60 (0.09), 0.90 (0.04), 0.73 (0.14), and 0.61 (0.08), respectively. Estimated intraclass correlation coefficients for basal cell layer thickness and papillary length increased from 0.38 and 0.56 to 0.69 and 0.95, respectively, when revised criteria were used. The draft criteria achieved promising levels of agreement when assessed independently by 5 pathologists. Further steps include evaluation of lesions without indicating the area to be assessed and exploring the correlation of microscopic esophagitis with symptoms and esophageal acid exposure.

Keywords: Consensus development, Esophageal histology, Esophagitis, Gastroesophageal reflux disease

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☆ AstraZeneca R&D, Mölndal, Sweden, provided economic support for travel arrangements, logistics, biopsy specimens/photos and statistical analyses.

☆☆ Conflicts of interest: None declared: R. Fiocca, L. Mastracci, R. Riddell, K. Takubo, M. Vieth, L. Yerian, P. Sharma. Employees of AstraZeneca: P. Fernström, M. Ruth.

PII: S0046-8177(09)00278-0

doi:10.1016/j.humpath.2009.07.016

Human Pathology
Volume 41, Issue 2 , Pages 223-231, February 2010

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