Gastric Neuromuscular Pathology in Gastroparesis: Analysis of Full-Thickness Antral Biopsies
- 451 Downloads
Pathologic assessment of gastric tissue in patients with gastroparesis is limited.
To evaluate gastric histopathology in patients with gastroparesis.
Full-thickness antral biopsies were obtained in 28 patients with gastroparesis. Control specimens were obtained from patients undergoing gastric resection. H&E and immunohistochemical stained slides were reviewed for the presence of inflammation, ganglion cells, and interstitial cells of Cajal (ICCs).
A mild lymphocytic infiltrate in the myenteric plexus was present in 6 out of 14 patients with diabetic gastroparesis (DG), one of 14 idiopathic gastroparesis (IG) and 0 of eight controls. Significant reductions in total nerve cell bodies were seen in gastroparesis patients (2.2 ± 0.3 per hpf; p = 0.0002) compared to controls (3.2 ± 0.12). This was seen in both DG (2.4 ± 0.32) and IG (2.0 ± 0.2). Sixteen patients (ten IG and six DG) had a reduction of ganglion cells (<2.3 cells/hpf). C-kit staining showed a reduction of ICCs in six patients (five IG and one DG). Four patients (three IG and one DG) had abnormal ICC morphology on C-kit staining with more rounded morphology and less dendritic processes.
This study shows several pathologic abnormalities in the gastric tissue in some patients with refractory gastroparesis. An inflammatory infiltrate was present in nearly half of the patients with diabetic gastroparesis. There was a reduction in nerve cell bodies in both idiopathic and diabetic gastroparesis. A reduced number of ICCs were found in the myenteric plexus. Thus, histologic abnormalities in gastroparesis are heterogeneous and include myenteric inflammation, decreased innervation, and reduction of ICCs.
KeywordsGastroparesis Interstitial cells of Cajal Nitric oxide
- 11.Lin Z, Sarosiek I, Forster J, Damjanov I, Hou Q, McCallum RW. Association of the status of interstitial cells of Cajal and electrogastrogram parameters, gastric emptying and symptoms in patients with gastroparesis. Neurogastroenterol Motil 2009;1–7. [Epub ahead of print].Google Scholar
- 14.Battaglia E, Bassotti G, Bellone G, Dughera L, et al. Loss of interstitial cells of Cajal network in severe idiopathic gastroparesis. World J Gastroenterol. 2006;14:6172–6177.Google Scholar
- 23.Pasricha PJ, Pehlivanov ND, Gomez G, Vittal H, Lurken MS, Farrugia G. Changes in the gastric enteric nervous system and muscle: a case report on two patients with diabetic gastroparesis. BMC Gastroenterol 2008;30;8:21.Google Scholar
- 29.Cooper EM, Barkin J. High-dose dexamethazone for acute idiopathic gastroparesis. Am J Gastroenterol. 2007;112:S516.Google Scholar
- 38.Lin Z, Forster J, Sarosiek I, Damjanov I, McCallum RW. Baseline status of interstitial cells of Cajal predicts long-term symptom improvement in gastroparetic patients treated with gastric electric stimulation. Gastroenterology. 2004;126(Suppl 2):A-73.Google Scholar