The difference between histological normalcy and abnormal is significantly variable from esophagus through rectum. There are geographical and ethnic (dietary?) differences. Criteria have been set for gastric biopsies (Sydney System) so that more than a rare plasma cell defines "chronic gastritis". Atrophic GI changes are greatly more difficult to discern histologically than they are endoscopically. So, proper interpretation of biopsies relies on the pathologist having knowledge of age, sex, the key clinical question to be addressed by the pathologist (for example, "watery diarrhea" workup or "celiac disease" workup), pertinent endoscopic positive or negative findings, and the key question to be answered ("UC, r/o dysplasia"). Clinicians are often concerned that provision of this info will cause "expectation bias" in the pathologist's interpretation; the pathologist "controls' for expectation bias by looking at the biopsies PRIOR to getting any further case information. When a pathologist uses the term "nonspecific" (for example, "nonspecific chronic gastritis"), it simply means that he/she is not in possession of enough histological or other information to achieve a more specific diagnosis. A good website for GI endoscopy photos of entities is HERE (see their online atlas and links to others in "notable websites").

There are some deviations from the ordinary that pathologists note for which there is as-yet-to-be-determined significance. For example, one sometimes notes a prominant fatty increased thickness of GI submucosa...submucosal "adiposity" [L07-9424]. At autopsy, one fairly frequently notes some small bowel mesentery nodularity...especially in thick, fatty mesenteries...which has a tan-yellowish cut surface involving fatty nodes with some perinodal fatty discoloration..."nodular mesenteric adenopathy". And, intra-abdominal malignancies in times past sometimes gave a first sign of recurrence as a "Sister Mary Joseph node", a palpable infraumbilical malignant metastatic mass [T07-130]. In biopsies or slides of any of the below, one might find (1) superficial brown epithelial cytoplasmic pigment of siderosis (a clue to oral intake of iron suppliments) or more limited to deep glandular cytoplasmic pigment (a clue to check for hemochromatosis in that patient [S07-12785]) or (2) calcinosis (too much Tums or other calcium intake or maybe patient has renal failure [S06-4610]).

• Esophageal disease:
  • polyps/tumors
  • esophagitides (including Barrett's esophagus)
  • motility
• gastric disease:
  • polyps/tumors
  • gastritides
  • motility
• small bowel (duodenal, jejunal, ileal) disease:
  • polyps/tumors
  • enteritides
  • disaccharidase & other special reference testing
  • motility
• vermiform appendix disease:
  • polyps/tumors
  • other
• colonic disease:
  • polyps/tumors
  • colitides
  • motility
• diagnostic modalities:
  • blood tests
  • breath tests: for Helicobacter
  • stool tests: for Giardia antigen, for Helicobacter antigen, for C. dif. toxin, for leukocytes
  • nuclear medicine tests: gastric emptying (see stomach @ this link) time; gallbladder HIDA scan commences biliary visualization in 5-10 minutes (not more than 20 min.) & GB filling begins by 20-30 minutes & begins into duodenum by 30 minutes; with cholecystokinin (CCK) stimulation, should eject no less than 50%; reproduction of the abdominal pain at whatever % ejection suggests dyskinesia & ejection less than 50% suggests dyskinesia..
  • imaging tests:
    • capsule endoscopy (CE)
    • direct endoscopic visualization
    • radiological: classical X-ray; fluoroscopy of upper GI series with or without small bowel follow through; CT scans; MRI; PET scans.
  • tissue (histology; histological) examinations 

(posted 9 February 2002; latest additions/update 21 October 2007)