title: Depletion of enteric gonadotropin-releasing hormone is found in a few patients suffering from severe gastrointestinal dysmotility.
abstract: OBJECTIVE
  Many patients, especially women, suffer from severe gastrointestinal pain and dysmotility for several years without being diagnosed. Depletion of gonadotropin-releasing hormone (GnRH) in the enteric nervous system (ENS) has been described in some patients. The aim of this study was to examine the expression of GnRH in ENS and antibodies against GnRH in serum, in a dysmotility patient cohort of southern Sweden.
  
  
  METHODS
  All consecutive patients (n = 35) referred for laparoscopic full-thickness biopsy because of symptoms or signs of severe dysmotility between 1998 and 2009, or patients with a severe dysmotility disorder having had a bowel resection within the time frame, were considered for inclusion. In 22 cases, representative biopsy material containing ganglia was available, and these patients were included. Medical records were scrutinized. The expression of GnRH was determined by immunohistochemistry in bowel biopsies from these patients and in patients with carcinoma or diverticulosis without ENS histopathology. Antibodies against GnRH in serum were determined by ELISA in patients and controls.
  
  
  RESULTS
  14 patients were diagnosed with enteric dysmotility (ED) and 8 with chronic intestinal pseudo-obstruction due to varying etiology. Immunostained biopsies showed expression of GnRH in the ENS. A reduced expression of GnRH-containing neurons was found in 5 patients, as well as antibodies against GnRH in serum. 3 of these patients had a history of in vitro fertilization (IVF) using GnRH analogs.
  
  
  CONCLUSIONS
  A subgroup of patients with severe dysmotility had a reduced expression of GnRH-containing neurons in the ENS and expressed antibodies against GnRH in serum.
authors: Department of Clinical Sciences, Section of Gastroenterology and Hepatology, Skåne University Hospital, Lund University, Malmö, Sweden. oskar.hammar@med.lu.se
authors: Oskar
authors: O
authors: Hammar
authors: Bodil
authors: B
authors: Ohlsson
authors: Béla
authors: B
authors: Veress
authors: Ragnar
authors: R
authors: Alm
authors: Gunilla Nordin
authors: GN
authors: Fredrikson
authors: Agneta
authors: A
authors: Montgomery
mesh_terms: D000328:Adult; D000906:Antibodies / Q000097:blood; D001706:Biopsy; D002277:Carcinoma / Q000150:complications* / Q000473:pathology; D002908:Chronic Disease; D004240:Diverticulum / Q000150:complications* / Q000473:pathology; D017615:Enteric Nervous System / Q000276:immunology / Q000473:pathology; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects; D005769:Gastrointestinal Motility / Q000276:immunology*; D007987:Gonadotropin-Releasing Hormone / Q000276:immunology*; D006801:Humans; D007150:Immunohistochemistry; D007414:Intestinal Neoplasms / Q000150:complications* / Q000473:pathology; D007418:Intestinal Pseudo-Obstruction / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D007422:Intestines / Q000276:immunology / Q000294:innervation / Q000473:pathology; D008297:Male; D015985:Precipitating Factors; D012720:Severity of Illness Index
chemical_list: D000906:Antibodies; D007987:Gonadotropin-Releasing Hormone