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Oesophageal and gastric biopsies — reflux, Barrett, achalasia, gastritis and gastric cancer
In oesophageal and gastric biopsies the site of the sample and the cellular pattern decide: in the oesophagus one distinguishes reflux, eosinophilic oesophagitis and Barrett, and in the stomach Helicobacter pylori gastritis (mainly antral), autoimmune gastritis (in the body) and chemical injury — each carrying a different cancer risk.
Why it matters in the exam
The bank asks about the distribution of inflammation and histological features. In reflux there is basal-layer hyperplasia, elongated papillae and scattered intraepithelial eosinophils; in eosinophilic oesophagitis there are 15 or more eosinophils per high-power field, along the whole oesophagus. Barrett is intestinal metaplasia with goblet cells above the gastro-oesophageal junction; it raises the risk of adenocarcinoma, and surveillance depends on the grade of dysplasia. In achalasia there is loss of ganglion cells in the myenteric plexus, and the exam uses a triad: failure of lower sphincter relaxation, increased sphincter tone and loss of peristalsis.
H. pylori gastritis is chronic active inflammation — with neutrophils — mainly in the antrum, and the organism is seen on the mucosal surface; it is linked to duodenal ulcer, MALT lymphoma and adenocarcinoma. Autoimmune gastritis involves the body and fundus and spares the antrum, with antibodies against parietal cells and intrinsic factor, loss of parietal cells, B12-deficiency anaemia and ECL-cell hyperplasia that can lead to a type 1 neuroendocrine tumour. Chemical injury (non-steroidal anti-inflammatory drugs, bile) shows foveolar hyperplasia with few inflammatory cells.
In gastric cancer the Lauren classification distinguishes an intestinal type — linked to H. pylori, metaplasia and dysplasia — from a diffuse type with "signet-ring" cells infiltrating the wall that can cause a rigid stomach (linitis plastica); an inherited CDH1 mutation causes hereditary diffuse gastric cancer and also raises the risk of lobular breast carcinoma. In advanced gastric cancer HER2, PD-L1 and MMR are tested to tailor treatment.
Key points
- Reflux: basal hyperplasia; eosinophilic oesophagitis: 15 or more per field.
- Barrett: intestinal metaplasia with goblet cells.
- Achalasia: loss of ganglion cells; no relaxation, raised tone, no peristalsis.
- H. pylori in the antrum; autoimmune in the body.
- Lauren: intestinal versus diffuse; CDH1 in hereditary diffuse cancer.
Summary table
| Condition | Site | Histological finding | Significance |
|---|---|---|---|
| Reflux | Distal oesophagus | Basal hyperplasia, elongated papillae | — |
| Eosinophilic oesophagitis | Whole oesophagus | 15 or more eosinophils per field | Food allergy |
| Barrett | Above the gastro-oesophageal junction | Intestinal metaplasia with goblet cells | Adenocarcinoma risk |
| H. pylori gastritis | Mainly antrum | Chronic active inflammation, organisms on mucosa | Ulcer, MALT, cancer |
| Autoimmune gastritis | Body and fundus | Loss of parietal cells, ECL-cell hyperplasia | B12 deficiency, neuroendocrine tumour |
Free exam questions
אחת הדרכים של הגוף להילח ם בזיהומים הנה באמצעות מחסומים שונים שהגוף מציב לגורמים המזהמים. חומציות הקיבה הוא מחסום חשוב שכן החומציות גורמת לסטריליזציה של מזהמים רבים אך לא של כולם. איזה מבין המזהמים הבאים הוא הרגיש ביותר ?לחומציות הקיבה (the question as examined, in Hebrew)
- א. Norovirus
- ב. Intestinal protozoal cyst
- ג. Vibrio cholerae
- ד. Intestinal helminthic eggs בחינת של ב א' אנטומיה פתולוגית 21.06.22
מה מהבאים נכון בהתייחס לאבנים בכיס המרה? (the question as examined, in Hebrew)
- א. אבני כולסטרול מורכבות בד"כ מכולסטרול טהור ) 100%
- ב. אבני פיגמנט חומות יימצאו לרוב בדרכי המרה הגדולות ולא בכיס המרה
- ג. כולסטרולוזיס תיווצר בד"כ במצבי סטזיס של כיס המרה
- ד. מעקף או קיצור קיבה קשורים ביצירה מוגברת של אבני פיגמנט
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Sources
- WHO Classification of Tumours: Digestive System Tumours, 5th edition (2019) — Oesophagus and stomach
- Updated Sydney System for classification and grading of gastritis, 1996 — Topography and grading
- Robbins and Cotran Pathologic Basis of Disease, 10th edition (2021) — The gastrointestinal tract — oesophagus and stomach
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.