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The London Classification of gastrointestinal neuromuscular pathology: report on behalf of the Gastro 2009 International Working Group
  1. Charles H Knowles1,
  2. Roberto De Giorgio2,
  3. Raj P Kapur3,
  4. Elisabeth Bruder4,
  5. Gianrico Farrugia5,
  6. Karel Geboes6,
  7. Greger Lindberg7,
  8. Joanne E Martin1,
  9. William A Meier-Ruge4,
  10. Peter J Milla8,
  11. Virpi V Smith9,
  12. Jean Marie Vandervinden10,
  13. Béla Veress11,
  14. Thilo Wedel12
  1. 1Neurogastroenterology Group, Centres for Academic Surgery and Pathology, Institute of Cellular and Molecular Science, Barts and the London, Queen Mary's School of Medicine and Dentistry, London, UK
  2. 2Department of Clinical Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
  3. 3Department of Pathology, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
  4. 4Institute of Pathology, University Hospital Basel, Basel, Switzerland
  5. 5Enteric NeuroScience Program, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  6. 6Department of Pathology, University Hospital Katholieke Universiteit Leuven, Leuven, Belgium
  7. 7Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
  8. 8UCL Institute of Child Health, London, UK
  9. 9Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital NHS Trust, London, UK
  10. 10Laboratory of Neurophysiology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
  11. 11Department of Clinical Pathology and Cytology, University Hospital MAS, Lunds University, Malmö, Sweden
  12. 12Anatomisches Institut, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
  1. Correspondence to Mr Charles H Knowles, Centre for Academic Surgery, 3rd Floor Alexandra Wing, Royal London Hospital, London E1 1BB, UK; c.h.knowles{at}


Objective Guidelines on histopathological techniques and reporting for adult and paediatric gastrointestinal neuromuscular pathology have been produced recently by an international working group (IWG). These addressed the important but relatively neglected areas of histopathological practice of the general pathologist, including suction rectal biopsy and full-thickness intestinal tissue. Recommendations were presented for the indications, safe acquisition of tissue, histological techniques, reporting and referral of such histological material.

Design Consensual processes undertaken by the IWG and following established guideline decision group methodologies.

Results and conclusion This report presents a contemporary and structured classification of gastrointestinal neuromuscular pathology based on defined histopathological criteria derived from the existing guidelines. In recognition of its origins and first presentation in London at the World Congress of Gastroenterology 2009, this has been named ‘The London Classification’. The implementation of this classification should allow some diagnostic standardisation, but should necessarily be viewed as a starting point for future modification as new data become available.

  • Achalasia
  • enteric neuromuscular disease
  • gastrointestinal motility
  • Hirschsprung disease
  • intestinal pseudo-obstruction
  • slow-transit constipation

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  • Funding This project is supported by an award from Gastro 2009 on behalf of cooperating societies (United European Gastroenterology Federation (UEGF), World Gastroenterology Organization (WGO), British Society of Gastroenterology (BSG), Organisation Mondiale d'Endoscopie Digestive (OMED)).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.