title: Depleted interstitial cells of Cajal and fibrosis in the pylorus: Novel features of gastroparesis.
abstract: Depletion and ultrastructural changes of interstitial cells of Cajal (ICC) in the gastric body and antrum have been observed in gastroparesis. This research was performed to investigate the ICC population in the muscularis propria and fibrosis of the muscular layer of the pylorus in gastroparesis.
  
  
  
  Full thickness pyloric and antral biopsies were obtained from 17 gastroparetic and 6 non-gastroparetic controls. Biopsies were stained with C-Kit for ICC and Trichrome for collagen fibrosis. Interstitial cells of Cajal depletion in the antrum was defined as mean ICC count <10 per 20 high power fields (HPF) based on established data.
  
  
  
  The average pyloric ICC count was ≥10/HPF in the control patients. Twelve (70.5%) gastroparetic patients had pyloric ICC loss. Only five patients (29.4%) had ICC loss in the antrum. Gastric emptying (GE) was not significantly different in patients with depleted vs normal pyloric ICC. However, GE at 2 h was slower in patients with antral ICC <10/HPF compared to those with normal antral ICC populations. Collagen fibrosis was observed in the pylorus of 14 (82.3%) patients. Inclusion bodies in the muscularis propria of the pylorus were identified in four patients, all with diabetic gastroparesis.
  
  
  
  In gastroparetic patients, ICC loss in the pylorus is twice as common as in the antrum and fibrosis in the pyloric smooth muscle is nearly three times more common than the antrum. These findings can provide one explanation for pyloric dysfunction which is a contributing factor to the pathophysiology of gastroparesis.
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, TX, USA.
authors.forename: S
authors.initials: S
authors.lastname: Moraveji
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, TX, USA.
authors.forename: M
authors.initials: M
authors.lastname: Bashashati
authors.affiliation: Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Elhanafi
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, TX, USA.
authors.forename: J
authors.initials: J
authors.lastname: Sunny
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, TX, USA.
authors.forename: I
authors.initials: I
authors.lastname: Sarosiek
authors.affiliation: Department of Surgery, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, TX, USA.
authors.forename: B
authors.initials: B
authors.lastname: Davis
authors.affiliation: Department of Pathology, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, TX, USA.
authors.forename: A
authors.initials: A
authors.lastname: Torabi
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, TX, USA.
authors.forename: R W
authors.initials: RW
authors.lastname: McCallum
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005355:Fibrosis; D005746:Gastric Emptying / Q000502:physiology; D018589:Gastroparesis / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D056885:Interstitial Cells of Cajal / Q000473:pathology* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000473:pathology / Q000502:physiology; D011708:Pylorus / Q000473:pathology* / Q000502:physiology
keywords: fibrosis; gastroparesis; interstitial cells of Cajal; pathology; pylorus