title: Ultrastructural differences between diabetic and idiopathic gastroparesis.
abstract: The ultrastructural changes in diabetic and idiopathic gastroparesis are not well studied and it is not known whether there are different defects in the two disorders. As part of the Gastroparesis Clinical Research Consortium, full thickness gastric body biopsies from 20 diabetic and 20 idiopathic gastroparetics were studied by light microscopy. Abnormalities were found in many (83%) but not all patients. Among the common defects were loss of interstitial cells of Cajal (ICC) and neural abnormalities. No distinguishing features were seen between diabetic and idiopathic gastroparesis. Our aim was to provide a detailed description of the ultrastructural abnormalities, compare findings between diabetic and idiopathic gastroparesis and determine if patients with apparently normal immunohistological features have ultrastructural abnormalities. Tissues from 40 gastroparetic patients and 24 age- and sex-matched controls were examined by transmission electron microscopy (TEM). Interstitial cells of Cajal showing changes suggestive of injury, large and empty nerve endings, presence of lipofuscin and lamellar bodies in the smooth muscle cells were found in all patients. However, the ultrastructural changes in ICC and nerves differed between diabetic and idiopathic gastroparesis and were more severe in idiopathic gastroparesis. A thickened basal lamina around smooth muscle cells and nerves was characteristic of diabetic gastroparesis whereas idiopathic gastroparetics had fibrosis, especially around the nerves. In conclusion, in all the patients TEM showed abnormalities in ICC, nerves and smooth muscle consistent with the delay in gastric emptying. The significant differences found between diabetic and idiopathic gastroparesis offers insight into pathophysiology as well as into potential targeted therapies.
authors.affiliation: University of Florence, Florence, Italy.
authors.forename: Maria Simonetta
authors.initials: MS
authors.lastname: Faussone-Pellegrini
authors.forename: Madhusudan
authors.initials: M
authors.lastname: Grover
authors.forename: Pankaj J
authors.initials: PJ
authors.lastname: Pasricha
authors.forename: Cheryl E
authors.initials: CE
authors.lastname: Bernard
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Lurken
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Smyrk
authors.forename: Henry P
authors.initials: HP
authors.lastname: Parkman
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Abell
authors.forename: William J
authors.initials: WJ
authors.lastname: Snape
authors.forename: William L
authors.initials: WL
authors.lastname: Hasler
authors.forename: Aynur
authors.initials: A
authors.lastname: Unalp-Arida
authors.forename: Linda
authors.initials: L
authors.lastname: Nguyen
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Koch
authors.forename: Jorges
authors.initials: J
authors.lastname: Calles
authors.forename: Linda
authors.initials: L
authors.lastname: Lee
authors.forename: James
authors.initials: J
authors.lastname: Tonascia
authors.forename: Frank A
authors.initials: FA
authors.lastname: Hamilton
authors.forename: Gianrico
authors.initials: G
authors.lastname: Farrugia
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003920:Diabetes Mellitus / Q000473:pathology* / Q000628:therapy; D003929:Diabetic Neuropathies / Q000473:pathology; D005260:Female; D005746:Gastric Emptying; D018589:Gastroparesis / Q000473:pathology* / Q000628:therapy; D006801:Humans; D056885:Interstitial Cells of Cajal / Q000473:pathology / Q000648:ultrastructure; D008297:Male; D046529:Microscopy, Electron, Transmission; D008875:Middle Aged; D013270:Stomach / Q000294:innervation* / Q000473:pathology / Q000648:ultrastructure*