Straightforward, unambiguous terminology can reduce the risk of labelling patients inappropriately
Whenever the definition of a diagnostic term is changed, a Pandora’s box of potential confusion is opened. Are all clinicians and research investigators using the same criteria? If a patient has been given a diagnostic label, does it refer to the old or the new definition? Barrett’s oesophagus has changed its definition more than once over the past five decades and is a prime example of how changing definitions causes confusion for clinicians and investigators alike.1,2 A solution to this problem lies in avoiding the potentially confusing term “Barrett’s oesophagus” altogether. Moreover, this is possible by using existing terminology without the need for any new definitions.
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- 1. Spechler SJ, Goyal RJ. The columnar-lined esophagus, intestinal metaplasia, and Norman Barrett. Gastroenterology 1996; 110: 614-621.
- 2. Chandrasoma P. Controversies of the cardiac mucosa and Barrett’s oesophagus. Histopathology 2005; 46: 361-373.
- 3. Chandrasoma PT, Der R, Dalton P, et al. Distribution and significance of epithelial types in columnar-lined esophagus. Am J Surg Pathol 2001; 25: 1188-1193.
- 4. Offerhaus GJ, Correa P, van Eeden S, et al. Report of an Amsterdam working group on Barrett esophagus. Virchows Arch 2003; 443: 602-608.
- 5. Goldblum JR. Barrett’s esophagus and Barrett’s-related dysplasia. Mod Pathol 2003; 16: 316-324.
- 6. Fléjou JF. Barrett’s oesophagus: from metaplasia to dysplasia and cancer. Gut 2005; 54 Suppl 1: i6-i12.
- 7. Werner M, Fléjou JF, Hainaut P. Tumours of the oesophagus. Adenocarcinoma. In: Hamilton SR, Aaltonen LA, editors. World Health Organization classification of tumours: pathology and genetics of tumours of the digestive system. Lyon: IARCPress, 2000: 20-26.
- 8. Skinner DB, Walther BC, Riddell RH, et al. Barrett’s esophagus. Comparison of benign and malignant cases. Ann Surg 1983; 198: 554-565.
- 9. Sampliner RE. Practice guidelines on the diagnosis, surveillance, and therapy of Barrett’s esophagus. The Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol 1998; 93: 1028-1032.
- 10. Armstrong D. Review article: towards consistency in the endoscopic diagnosis of Barrett’s oesophagus and columnar metaplasia. Aliment Pharmacol Ther 2004; 20 Suppl 5: 40-47.
- 11. Faller G, Borchard F, Ell C, et al. Histopathological diagnosis of Barrett’s mucosa and associated neoplasias: results of a consensus conference of the Working Group for Gastroenterological Pathology of the German Society for Pathology on 22 September 2001 in Erlangen. Virchows Arch 2003; 443: 597-601.
- 12. Playford RJ. New British Society of Gastroenterology (BSG) guidelines for the diagnosis and management of Barrett’s oesophagus [commentary]. Gut 2006; 55: 442-443.
- 13. Hellier MD, Shepherd NA. Diagnosis of columnar-lined oesophagus. In: Watson A, Heading RC, Shepherd NA, editors. Guidelines for the diagnosis and management of Barrett’s columnar-lined oesophagus. A report of the Working Party of the British Society of Gastroenterology. August 2005. http://www.bsg.org.uk/pdf_word_docs/Barretts_Oes.pdf (accessed Jan 2007).
- 14. Murray L, Watson P, Johnston B, et al. Risk of adenocarcinoma in Barrett’s oesophagus: population based study. BMJ 2003; 327: 534-535.
- 15. Murphy SJ, Johnston BT, Murray LJ. British Society of Gastroenterology guidelines for the diagnosis of Barrett’s oesophagus: are we casting the net too wide [letter]? Gut 2006; 55: 1821-1822.
- 16. Riddell RH. The genesis of Barrett esophagus: has a histologic transition from gastroesophageal reflux disease-damaged epithelium to columnar metaplasia ever been seen in humans? Arch Pathol Lab Med 2005; 129: 164-169.
- 17. Sharma P, Weston AP, Morales T, et al. Relative risk of dysplasia for patients with intestinal metaplasia in the distal oesophagus and in the gastric cardia. Gut 2000; 46: 9-13.
- 18. Rogge-Wolf C, Seldenrijk CA, Das KM, et al. Prevalence of mabDAS-1 positivity in biopsy specimens from the esophagogastric junction. Am J Gastroenterol 2002; 97: 2979-2985.
- 19. DeMeester SR, Wickramasinghe KS, Lord RV, et al. Cytokeratin and DAS-1 immunostaining reveal similarities among cardiac mucosa, CIM, and Barrett’s esophagus. Am J Gastroenterol 2002; 97: 2514-2523.
- 20. Phillips RW, Frierson HF, Moskaluk CA. Cdx2 as a marker of epithelial intestinal differentiation in the esophagus. Am J Surg Pathol 2003; 27: 1442-1447.
- 21. Liu GS, Gong J, Cheng P. Distinction between short-segment Barrett’s esophageal and cardiac intestinal metaplasia. World J Gastroenterol 2005; 11: 6360-6365.
- 22. Glickman JN, Wang H, Das KM, et al. Phenotype of Barrett’s esophagus and intestinal metaplasia of the distal esophagus and gastroesophageal junction: an immunohistochemical study of cytokeratins 7 and 20, Das-1 and 45 MI. Am J Surg Pathol 2001; 25: 87-94.
- 23. Odze RD. Unraveling the mystery of the gastroesophageal junction: a pathologist’s perspective. Am J Gastroenterol 2005; 100: 1853-1867.
- 24. Kilgore SP, Ormsby AH, Gramlich TL, et al. The gastric cardia: fact or fiction? Am J Gastroenterol 2000; 95: 921-924.
- 25. De Hertogh G, Van Eyken P, Ectors N, et al. On the existence and location of cardiac mucosa: an autopsy study in embryos, fetuses, and infants. Gut 2003; 52: 791-796.
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