INTEROBSERVER VARIATION IN ASSESSMENT OF GASTRODUODENAL LESIONS ASSOCIATED WITH NONSTEROIDAL ANTIINFLAMMATORY DRUGS

Video endoscopic images were used to investigate whether gastroenterol ogists could agree on the definition of lesions within the stomach see n at endoscopy, with particular reference to those seen in patients ta king non-steroidal antiinflammatory drugs. Seven experienced endoscopi sts, unaware of the patients' clinical history or drug consumption, re corded their classification for 93 randomised video images of gastric lesions. There was complete agreement in the diagnosis of ulceration f or nine images from patients who were not taking non-steroidal anti-in flammatory drugs; eight of nine were classified as deep ulcers, with 8 6% agreement for this subclassification. By contrast, the overall agre ement for lesions in patients taking non-steroidal anti-inflammatory d rugs was only 55%. Only nine of 44 ulcers were subclassified as deep, and there was considerable cross classification of non-haemorrhagic er osions and deers. In conclusion, ulcers that occur in patients taking non-steroidal anti-inflammatory drugs differ from those in patients wh o are not taking these drugs in that they are often more superficial a nd difficult to distinguish from erosions. The prognostic importance o f these lesions is, therefore, uncertain.