Gastrointestinal neuromuscular pathology: guidelines for histological techniques and reporting on behalf of the Gastro 2009 International Working Group.
The term gastrointestinal neuromuscular disease describes a clinically heterogeneous group of disorders of children and adults in which symptoms are presumed or proven to arise as a result of neuromuscular, including interstitial cell of Cajal, dysfunction. Such disorders commonly have impaired motor activity, i.e. slowed or obstructed transit with radiological evidence of transient or persistent visceral dilatation. Whilst sensorimotor abnormalities have been demonstrated by a variety of methods in these conditions, standards for histopathological reporting remain relatively neglected. Significant differences in methodologies and expertise continue to confound the reliable delineation of normality and specificity of particular pathological changes for disease. Such issues require urgent clarification to standardize acquisition and handling of tissue specimens, interpretation of findings and make informed decisions on risk-benefit of full-thickness tissue biopsy of bowel or other diagnostic procedures. Such information will also allow increased certainty of diagnosis, facilitating factual discussion between patients and caregivers, as well as giving prognostic and therapeutic information. The following report, produced by an international working group, using established consensus methodology, presents proposed guidelines on histological techniques and reporting for adult and paediatric gastrointestinal neuromuscular pathology. The report addresses the main areas of histopathological practice as confronted by the pathologist, including suction rectal biopsy and full-thickness tissue obtained with diagnostic or therapeutic intent. For each, indications, safe acquisition of tissue, histological techniques, reporting and referral recommendations are presented.
Neurogastroenterology Group, Centres for Academic Surgery and Pathology, Institute of Cellular and Molecular Science, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, Whitechapel, UK. c.h.knowles@qmul.ac.uk
Charles H
CH
Knowles
Roberto
R
De Giorgio
Raj P
RP
Kapur
Elisabeth
E
Bruder
Gianrico
G
Farrugia
Karel
K
Geboes
Michael D
MD
Gershon
John
J
Hutson
Greger
G
Lindberg
Joanne E
JE
Martin
William A
WA
Meier-Ruge
Peter J
PJ
Milla
Virpi V
VV
Smith
Jean Marie
JM
Vandervinden
Béla
B
Veress
Thilo
T
Wedel
D000328:Adult; D002648:Child; D017615:Enteric Nervous System / Q000473:pathology*; D005260:Female; D005767:Gastrointestinal Diseases / Q000473:pathology*; D016591:Histocytological Preparation Techniques; D006801:Humans; D008297:Male; D009468:Neuromuscular Diseases / Q000473:pathology*