Seventh O.E.S.O. Congress: Gastroesophageal Reflux and Barrett Esophagus

Archives of Pathology & Laboratory Medicine, Feb 2005 by Chejfec, Gregorio, Appelman, Henry D

On September 3, 2003, a group of distinguished pathologists and clinicians gathered at the most recent meeting of the Congress of the QE.S.O. in Paris, France. This issue of the Archives of Pathology & Laboratory Medicine includes the lectures given by each of the presenters at this meeting.

O.E.S.Q are the initials for the Organisation mondiale d'Etudes Sp�cialis�es sur les maladies de l'Oesophage, a French association dedicated to study of the esophagus. The English equivalent is World Organization for Specialized Studies on Diseases of the Esophagus. The initials of the French name are also the first 4 letters in the European spelling for the first part of the digestive tract, the oesophagus, so the acronym is very appropriate. This association was established in the late 1970s by an innovative French esophageal surgeon, Robert Giuli, who is still its guiding light. Dr Giuli had the foresight to recognize the need for bringing together physicians and scientists of many disciplines to exchange information on normal functions and diseases of the esophagus. He organized the first international O.E.S.O. Congress in Paris in 1984, and subsequent Congresses have been held in Paris in 1987, 1990, 1993, 1996, 2000, and 2003. These Congresses have brought together surgeons, gastroenterologists, pediatricians, radiologists, epidemiologists, pathologists, pharmacologists, biochemists, anatomists, and physiologists to discuss the most recent advances in esophageal disorders. The proceedings of each of these Congresses have been published as books, which are virtual encyclopedias of esophageal form and function, both normal and abnormal. The Congresses have become venues for pathologists to rub elbows with a variety of clinicians, and the pathologists feel welcomed and comfortable and are valuable contributors to this multidisciplinary activity. Pathologists who have been active participants and planners in these Congresses, many of whom are the most esteemed gastrointestinal pathologists in the world, include (from North America) Don Antonioli, Henry Appelman, Parakrama Chandrasoma, Greg Chejfec, Palayo Correa, Kim Geisinger, John Goldblum, Rodger Haggitt, Stanley Hamilton, Jeff Lee, Klaus Lewin, Liz Montgomery, Rob Adze, Bob Riddell, and Mamoun Younes. From Europe, the United Kingdom, and Japan, past participants and planners include Wladimir Bogomoletz, Mike Dixon, Nadine Ectors, Jean-Fran�ois Flejou, Annie Galian, Daniel Gardiol, Bob Genta, Karel Geboes, David Hopwood, Francois Potet, Neil Shepherd, Pentti Sipponen, Manfred Stolte, Kaiyo Takubo, Elizabeth Tschanz, and Michael Veith. In 4 of the past 6 Congresses, there have been symposia, ranging from 2 to 4 hours, devoted to the pathology of the esophagus, and many of the pathologists listed above have given lectures during these symposia.

The theme of the 2003 pathology symposium was metaplasia of the esophageal mucosa, whereby the squamous epithelium is replaced by mucosa lined with columnar epithelium and containing mucus-producing goblet cells. This condition is hereinafter referred to as Barrett metaplasia in honor of Norman Barrett, whose pioneer work first attracted the attention of investigators in this field.

The initial lectures at the 2003 symposium were devoted to gastroesophageal reflux disease, ultimately associated with the development of Barrett metaplasia. In keeping with previous O.E.S.Q meetings, each one of the presentations was a response to a specific question. Kaiyo Takubo (Tokyo Metropolitan Institute of Gerontology) answered the first question: "Is there a set of histologie changes that are invariably reflux associated?" The second question, "Has a histologic transition from GERD-damaged epithelium to columnar metaplasia ever been seen in humans?" was discussed by Robert Riddell (Mount Sinai Hospital, Toronto, Ontario).

Following these introductory discussions, attention was concentrated on the neoplastic potential of the metaplastic mucosa. The subject of dysplasia was the center of attention.

Appropriately, Henry Appelman (University of Michigan, Ann Arbor) opened this portion of the symposium with an eloquent dissertation, "What is dysplasia?" Interobserver variability in the diagnosis of dysplasia was thoroughly analyzed by Elizabeth Montgomery (Johns Hopkins, Baltimore, Md).

The wide variation in the incidence of adenocarcinomas associated with Barrett metaplasia was addressed by Elizabeth R. Tschanz (H�pitaux Universitaires de Gen�ve, Geneva) in collaboration with Robert Genta (Geneva).

The features distinguishing adenocarcinoma of the esophagogastric junction from Barrett adenocarcinoma were discussed by Nadine Ectors (University Hospitals Leuven, Leuven, Belgium). The final presentation was by Mamoun Younes (Baylor College of Medicine, Houston, Tex), who discussed the role of cytokeratins in the identification of the mucosa of the gastric cardia and Barrett metaplastic mucosa.

The ARCHIVES is pleased to reproduce the text of the 2003 O.E.S.O. presentations. We hope our readers will benefit from the experience of these well-known investigators.