What did you think about the recent AJSP article

[pathstudent]

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Did you read the article in the recent AJSP proving that the whole gastric cardia does not exist as a normal histologic entity but is actually due to reflux, and is basically early metaplasia due to dilatation of the esophagus. Interesting. I have seen some Dist Eso biopsies where the squamous mucosa ran straight into oxyntic mucosa with no cardia.

It is a revolutionary article.

 

[pathstudent]

Well I guess people don't think much about it, but I find it fascinating that part of the GI histology canon is that the stomach consists of the cardia, oxyntic and antral mucosa has been turned on its head.

It is amazing that things we take for granted as truth and as normal are still false. It goes to show you that everything we "know" about medicine will once be regarded as absurd as the ptolemian view of the Universe. the authors of that article are mini-coperinicuses.

my colleagues always joke that it is stupid to have a new histology for pathologists as nothing changes. well, normal histology just had a mini-earthquake with the publication of that article. Histology will have to be revised.

 

[KCShaw]

I haven't read the article, but then again I also never really bothered distinguishing stomach mucosa from stomach mucosa. I also tend towards the view that "normal" generally just means "common," not that there is some magic line between perfect health and OMG. Obviously I'd have to read the article, but calling something metaplastic also doesn't make (or not make) an unhealthy norm. Still, I guess I'm just not surprised someone is calling something evidently quite common an unhealthy norm.

Tangentially, I generally doubt a person who weighs 331 lbs and has a heart weight of 633 g should automatically be considered "healthy" simply because a table says that's within the "normal" range of heart weight for that body weight.

 

[pathstudent]

I haven't read the article, but then again I also never really bothered distinguishing stomach mucosa from stomach mucosa. I also tend towards the view that "normal" generally just means "common," not that there is some magic line between perfect health and OMG. Obviously I'd have to read the article, but calling something metaplastic also doesn't make (or not make) an unhealthy norm. Still, I guess I'm just not surprised someone is calling something evidently quite common an unhealthy norm.

Tangentially, I generally doubt a person who weighs 331 lbs and has a heart weight of 633 g should automatically be considered "healthy" simply because a table says that's within the "normal" range of heart weight for that body weight.

Stomach mucosa is not just stomach mucosa. There are major physiological differences between Oxyntic and Antral mucosa, plus in terms of diagnosing disease it matters immensely where you are. for instance, you can only assess atrophy in the oxyntic mucosa.

To me proving the cardia is no longer a histologically normal entity is like discovering a 207th bone or a 13th cranial nerve. It changes everything.

 

[Pathologee]

To me proving the cardia is no longer a histologically normal entity is like discovering a 207th bone or a 13th cranial nerve. It changes everything.

To me it proves that GI pathologists are the most anal of all pathologists, which is an intrinsically anal field.

 

[deleted314957]

Stomach mucosa is not just stomach mucosa. There are major physiological differences between Oxyntic and Antral mucosa, plus in terms of diagnosing disease it matters immensely where you are. for instance, you can only assess atrophy in the oxyntic mucosa.

To me proving the cardia is no longer a histologically normal entity is like discovering a 207th bone or a 13th cranial nerve. It changes everything.

" you can only assess atrophy in the oxyntic mucosa" is not true. However i think i know what you are getting at. you are probably referring to autoimmune atrophic gastritis affecting the body mucosa which, after atrophy and pseudo pyloric metaplasas, can be demonstrated as truly(originally) body mucosa by absense of G cells. Chronic quiescent atrophic gastritis, usually helicobacter associated, certainly can affect the antrum.

as regards the "cardia -type mucosa", this has been kicked around for several years in the gi literature---is it real, is it only in little kids, is it a form of metaplasia associated with reflux,what is the significance of IM in cardia mucosa,etc.
If you did a search you would find lots of literature within the past 10 years.

 

[pathstudent]

" you can only assess atrophy in the oxyntic mucosa" is not true. However i think i know what you are getting at. you are probably referring to autoimmune atrophic gastritis affecting the body mucosa which, after atrophy and pseudo pyloric metaplasas, can be demonstrated as truly(originally) body mucosa by absense of G cells. Chronic quiescent atrophic gastritis, usually helicobacter associated, certainly can affect the antrum.

as regards the "cardia -type mucosa", this has been kicked around for several years in the gi literature---is it real, is it only in little kids, is it a form of metaplasia associated with reflux,what is the significance of IM in cardia mucosa,etc.
If you did a search you would find lots of literature within the past 10 years.

Please .....I know all the literature. IMO this is the definitive proof.

Yes and of course I am talking about autoimmune gastritis!

 

[Torsed]

Please .....I know all the literature. IMO this is the definitive proof.

Yes and of course I am talking about autoimmune gastritis!

Wish my life were so easy as to know all the literature. I guess the big question is do gastroenterologists care?!

 

[2121115]

Wish my life were so easy as to know all the literature. I guess the big question is do gastroenterologists care?!

GI docs care about making $$$ off of the backs of "type B" GI pathologists.