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Kyoto international consensus report on anatomy, pathophysiology and clinical significance of the gastro-oesophageal junction

Sugano K 1 , Spechler SJ 2 , El-Omar EM 3 , McColl KEL 4 , Takubo K 5 , Gotoda T 6 Show all authors , Fujishiro M 7 , Iijima K 8 , Inoue H 9 , Kawai T 10 , Kinoshita Y 11 , Miwa H 12 , Mukaisho KI 13 , Murakami K 14 , Seto Y 15 , Tajiri H 16 , Bhatia S 17 , Choi MG 18 , Fitzgerald RC 19 , Fock KM 20 , Goh KL 21 , Ho KY 22 , Mahachai V 23 , O'Donovan M 24 , Odze R 25 , Peek R 26 , Rugge M 27 , Sharma P 28 , Sollano JD 29 , Vieth M 30 , Wu J 31 , Wu MS 32 , Zou D 33 , Kaminishi M 34 , Malfertheiner P 35

Affiliations 

  • 1 Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan sugano@jichi.ac.jp
  • 2 Division of Gastroenterology, Center for Esophageal Diseases, Baylor University Medical Center, Dallas, Texas, USA
  • 3 Microbiome Research Centre, St George & Sutherland Clinical Campuses, School of Clinical Medicine, Faculty of Medicine & Health, Sydney, New South Wales, Australia
  • 4 Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
  • 5 Research Team for Geriatric Pathology, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
  • 6 Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
  • 7 Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  • 8 Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan
  • 9 Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
  • 10 Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
  • 11 Hyogo-prefectural Harima-Himeji General Medical Center, Himeji, Japan
  • 12 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Kobe, Japan
  • 13 Education Center for Medicine and Nursing, Shiga University of Medical Science, Otsu, Japan
  • 14 Department of Gastroenterology, Oita University Faculty of Medicine, Yuhu, Japan
  • 15 Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  • 16 Jikei University School of Medicine, Minato-ku, Tokyo, Japan
  • 17 Sir HN Reliance Foundation Hospital, Mumbai, India
  • 18 Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, The Republic of Korea
  • 19 Medical Research Council Cancer Unit, Hutchison/Medical Research Council Research Centre, University of Cambridge, Cambridge, UK
  • 20 Department of Gastroenterology and Hepatology, Duke NUS School of Medicine, National University of Singapore, Singapore
  • 21 University of Malaya, Kuala Lumpur, Malaysia
  • 22 Department of Medicine, National University of Singapore, Singapore
  • 23 Center of Excellence in Digestive Diseases, Thammasat University and Science Resarch and Innovation, Bangkok, Thailand
  • 24 Department of Histopathology, Cambridge University Hospital NHS Trust UK, Cambridge, UK
  • 25 Department of Pathology, Tuft University School of Medicine, Boston, Massachusetts, USA
  • 26 Vanderbilt University Medical Center, Nashville, Tennessee, USA
  • 27 Department of Medicine DIMED, Surgical Pathology and Cytopathology Unit, University of Padova, Padova, Italy
  • 28 Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas, USA
  • 29 Department of Medicine, University of Santo Tomas, Manila, Philippines
  • 30 Institute of Pathology, Klinikum Bayreuth, Friedrich-Alexander University Erlangen, Nurenberg, Germany
  • 31 Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
  • 32 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  • 33 Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  • 34 Showa General Hospital, Tokyo, Japan
  • 35 Medizinixhe Klinik und Poliklinik II, Ludwig Maximillian University Klinikum, Munich, Germany
Gut, 2022 Aug;71(8):1488-1514.
PMID: 35725291 DOI: 10.1136/gutjnl-2022-327281

Abstract

OBJECTIVE: An international meeting was organised to develop consensus on (1) the landmarks to define the gastro-oesophageal junction (GOJ), (2) the occurrence and pathophysiological significance of the cardiac gland, (3) the definition of the gastro-oesophageal junctional zone (GOJZ) and (4) the causes of inflammation, metaplasia and neoplasia occurring in the GOJZ.

DESIGN: Clinical questions relevant to the afore-mentioned major issues were drafted for which expert panels formulated relevant statements and textural explanations.A Delphi method using an anonymous system was employed to develop the consensus, the level of which was predefined as ≥80% of agreement. Two rounds of voting and amendments were completed before the meeting at which clinical questions and consensus were finalised.

RESULTS: Twenty eight clinical questions and statements were finalised after extensive amendments. Critical consensus was achieved: (1) definition for the GOJ, (2) definition of the GOJZ spanning 1 cm proximal and distal to the GOJ as defined by the end of palisade vessels was accepted based on the anatomical distribution of cardiac type gland, (3) chemical and bacterial (Helicobacter pylori) factors as the primary causes of inflammation, metaplasia and neoplasia occurring in the GOJZ, (4) a new definition of Barrett's oesophagus (BO).

CONCLUSIONS: This international consensus on the new definitions of BO, GOJ and the GOJZ will be instrumental in future studies aiming to resolve many issues on this important anatomic area and hopefully will lead to better classification and management of the diseases surrounding the GOJ.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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