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Quantitative computer-assisted image analysis of suction biopsy in pediatric gastroesophageal reflux
C J DiGiorgio1, S R Orenstein, T M Shalaby
1Division of Cellular and Molecular Pathology, University of Pittsburgh School of Medicine, Pennsylvania 15213.
Insights
This study introduces a new computer-assisted method to objectively evaluate esophageal biopsies in infants with gastroesophageal reflux. This quantitative approach reliably categorizes reflux esophagitis, aiding future research into the condition.
Area of Science:
- Pediatric Gastroenterology
- Histopathology
- Medical Imaging Analysis
Background:
- Gastroesophageal reflux (GER) histopathology is well-defined in adults, but poorly understood in children.
- Epithelial injury and its pathogenesis in pediatric reflux esophagitis require further investigation.
Purpose of the Study:
- To describe and validate a quantitative histopathologic method for evaluating esophageal biopsies in infants with reflux symptoms.
- To assess the reliability and applicability of computer-assisted image analysis for pediatric reflux esophagitis.
Main Methods:
- Esophageal suction biopsies from 80 infants with reflux symptoms were analyzed.
- Computer-assisted image analysis quantified histological features: intraepithelial lymphocytes/eosinophils, papillary height, interpapillary basal cell height, and integrated basal cell height.
- Quantitative results were compared to subjective grades of esophagitis (low, mild, moderate, high).
Main Results:
- The quantitative method demonstrated sufficiently low inter- and intra-observer variability.
- Objective analysis reliably stratified mucosal changes into at least four distinct categories.
- This technique provides a reliable means to assess pediatric reflux esophagitis.
Conclusions:
- A novel, objective, computer-assisted histopathologic method for pediatric esophageal biopsies has been established.
- This reliable quantitative technique enables robust studies on the progression and regression of pediatric reflux esophagitis.
- The method facilitates a deeper understanding of epithelial injury in infant reflux.
Abstract:
Gastroesophageal reflux is a disorder with well-characterized histopathological features in the adult, but the incidence and pathogenesis of epithelial injury in children are poorly understood. Esophageal suction biopsies from 80 infants exhibiting symptoms of reflux were studied by computer-assisted image analysis and the results compared to routine histological scoring. The histological features evaluated were the number of intraepithelial lymphocytes and eosinophils, papillary height, interpapillary basal cell height, and a novel measure "integrated basal cell height." We quantitatively evaluated these histological criteria by computer-assisted image analysis and compared these results to four subjective grades of esophagitis: low, mild, moderate and high. In this report we now describe this quantitative histopathologic method for the evaluation of pediatric esophageal biopsies. Utilizing this method we demonstrate that both inter- and intra-observer variability were sufficiently low to stratify the mucosal changes reliably into at least four categories. The reliability of this objective analytic technique will permit studies into the disease progression and regression in pediatric reflux esophagitis.
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