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

Roberto Fiocca, Luca Mastracci, Robert Riddell, Kaiyo Takubo, Michael Vieth, Lisa Yerian, Prateek Sharma, Paula Fernström, Magnus Ruth

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)223-231
Number of pages9
JournalHuman Pathology
Volume41
Issue number2
DOIs
Publication statusPublished - Feb 2010

Keywords

  • Consensus development
  • Esophageal histology
  • Esophagitis
  • Gastroesophageal reflux disease

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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