The diseases of the gastrointestinal tract include a broad spectrum of entities that differ in their aetiopathogenesis, morphology and biology. The pathologist plays a pivotal role in the multidisciplinary team in the diagnosis of these changes. It requires a high degree of specialisation with profound clinical experience including familiarity with current guidelines.
Modern endoscopic examination techniques such as high-resolution endoscopy, narrow-band imaging and chromoendoscopy enable targeted biopsies from lesions throughout the entire gastrointestinal tract. The introduction of minimal invasive procedures like mucosal resection and submucosal dissection have led to a new curative and organ-sparing approach in the management of certain diseases. New information on molecular tumour biology have shifted clinical and therapeutic management towards individualised therapy.
The national endoscopic screening programmes also challenge pathologists:
- quantitative – measured by the steadily increasing number of biopsies for each examination procedure,
- cut up – in terms of the requirements for a precisely documented examination of mucosal resection specimens, and
- methods – increased number of immunohistochemical and molecular pathological analyses.
Gastrointestinal pathology has been an established focus in our department for more than 15 years. Biopsies and surgical specimens from the gastrointestinal tract make the majority of the cases we receive, coming from more than 50 clinics/private practices and hospital departments, nationwide and from abroad. Our specialist medical and scientific expertise in this area is documented by a string of publications, presentations, tutorials and lectures. The diagnostics we carry out in close collaboration with our partners who perform molecular pathology covers the entire spectrum of gastrointestinal pathology including for the upper gastrointestinal tract:
- diagnosis of pathogen-induced inflammatory changes of the oesophagus, the stomach and the small intestine, particularly the detection of herpes, CMV, fungi and Helicobacter (if required, using immunohistochemistry and/or molecular pathology),
- classification of non-pathogen-induced inflammation such as eosinophilic oesophagitis, autoimmune and reactive gastritis, diagnosis of coeliac disease,
- typing of reflux-induced changes of the oesophagus and cardia including metaplastic and neoplastic transformation (e.g. in Barrett’s oesophagus),
- diagnosis of epithelial, mesenchymal and lymphoid neoplasms, if necessary using immunohistochemistry or molecular pathology (e.g. HER2 status or KRAS, NRAS and BRAF mutation analysis)
and for the lower gastrointestinal tract:
- diagnosis of colitis, particularly classification of idiopathic chronic inflammatory bowel diseases and associated neoplasms,
- diagnosis of Lynch syndrome including mismatch repair protein-immunohistochemistry, analysis of microsatellite instability and mutation screening,
- classification of colorectal polyps and polyposes,
- diagnosis of neoplastic diseases (with the same techniques as described above for cancers of the upper gastrointestinal tract).