title: Gastric neuromuscular pathology in gastroparesis: analysis of full-thickness antral biopsies.
abstract: BACKGROUND
  Pathologic assessment of gastric tissue in patients with gastroparesis is limited. Aims To evaluate gastric histopathology in patients with gastroparesis.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Gastrointestinal Section, Department of Medicine, Temple University School of Medicine, Parkinson Pavilion, 8th Floor, 3401 North Broad Street, Philadelphia, PA 19140, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Harberson
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Thomas
authors.forename: Sean P
authors.initials: SP
authors.lastname: Harbison
authors.forename: Henry P
authors.initials: HP
authors.lastname: Parkman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D018589:Gastroparesis / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D056885:Interstitial Cells of Cajal / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009197:Myenteric Plexus / Q000473:pathology*; D019001:Nitric Oxide Synthase / Q000378:metabolism; D010751:Phosphopyruvate Hydratase / Q000378:metabolism; D011706:Pyloric Antrum / Q000294:innervation / Q000378:metabolism / Q000473:pathology*; D009418:S100 Proteins / Q000378:metabolism; D055815:Young Adult
chemical_list: D009418:S100 Proteins; D019001:Nitric Oxide Synthase; D010751:Phosphopyruvate Hydratase