Anatomic Pathology, San Martino IRCCS Hospital, Genova, Italy.
Anatomic Pathology, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Italy.
Pathologica. 2020 Sep;112(3):117-127. doi: 10.32074/1591-951X-162.
The first part of this overview on non-neoplastic esophagus is focused on gastro-esophageal reflux disease (GERD) and Barrett's esophagus. In the last 20 years much has changed in histological approach to biopsies of patients with gastro-esophageal reflux disease. In particular, elementary histologic lesions have been well defined and modality of evaluation and grade are detailed, their sensitivity and specificity has been evaluated and their use has been validated by several authors. Also if there is not a clinical indication to perform biopsies in patient with GERD, the diagnosis of microscopic esophagitis, when biopsies are provided, can be performed by following simple rules for evaluation which allow pathologists to make the diagnosis with confidence. On the other hand, biopsies are required for the diagnosis of Barrett's esophagus. This diagnosis is the synthesis of endoscopic picture (which has to be provided with the proper description on extent and with adequate biopsies number) and histologic pattern. The current guidelines and expert opinions for the correct management of these diagnosis are detailed.
本综述的第一部分重点介绍非肿瘤性食管,包括胃食管反流病(GERD)和 Barrett 食管。在过去的 20 年中,胃食管反流病患者活检的组织学方法发生了很大变化。特别是,基本的组织学病变已经得到了很好的定义,评估和分级的方式也很详细,其敏感性和特异性已经得到了多位作者的评估和验证。尽管对于 GERD 患者没有进行活检的临床指征,但当提供活检时,可以通过遵循简单的评估规则来诊断微观食管炎,这使得病理学家能够有信心做出诊断。另一方面,活检是诊断 Barrett 食管所必需的。该诊断是内镜图像(必须提供适当的描述,包括范围和足够数量的活检)和组织学模式的综合。详细介绍了目前用于正确管理这些诊断的指南和专家意见。
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