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Getting to Grips With Gastric Pathology

The purpose of this article is to offer an overall approach to gastric mucosal disorders in children. In collaboration with a pathologist who has special expertise in gastrointestinal histopathology, the pediatric endoscopist can gain a wealth of useful information. This lode of information can be mined without much difficulty, but requires attention to detail and accuracy. In children, gastric mucosal disorders are underrecognized and poorly characterized, probably because of the flawed tendency to rely on macroscopic appearances at endoscopy, the use of imprecise and nonstandardized descriptive terminology, and an apparent reluctance to take multiple gastric biopsy specimens. Practical advice for endoscopists about endoscopic landmarks, terminology, and acquisition of biopsy specimens may facilitate consistency of communication among endoscopists, and between endoscopists and pathologists. The author aims to propose an approach to, and a classification of, gastric mucosal disorders that is pertinent to practicing pediatric endoscopists, focusing attention on this little-studied area and facilitating diagnosis or exclusion of the various entities that comprise the classification. This will serve the ultimate goal of accurate diagnosis and an appropriate approach to the child under our care. In addition, with adequate biopsy specimen harvesting and careful tissue handling, a quantity and quality of tissue can be obtained to enable scientific studies, the results of which can be taken back to the bedside for the benefit of many children. For many years, Professor Walker-Smith and his team have successfully taken clinical material to the lab and scientific studies back to the clinic. In short, the pediatric endoscopist can obtain a wealth of useful information for direct clinical care and for scientific study. In this regard the importance of collaboration with a pathologist who has special expertise in gastrointestinal histopathology cannot be overstressed.