title: Gastric neuromuscular histology in patients with refractory gastroparesis: Relationships to etiology, gastric emptying, and response to gastric electric stimulation.
abstract: BACKGROUND
  The aims of this study were to describe the histology in gastroparesis, specifically to relate histopathology to etiology of gastroparesis (idiopathic and diabetic gastroparesis), gastric emptying, and clinical response to gastric electric stimulation.
  
  
  METHODS
  Full thickness gastric body sections obtained during insertion of gastric stimulator in gastroparetics were stained with Hematoxylin & Eosin, Masson Trichrome and immunohistochemical stains for Neuron-Specific Enolase and c-Kit.
  
  
  RESULTS
  In all, 145 gastroparetics (71 diabetics, 71 idiopathic, 2 post-surgical, and 1 chronic intestinal pseudo-obstruction) had full thickness gastric body biopsies. A lymphocytic infiltrate was seen in the intermyenteric plexus in 22 diabetic and 23 idiopathic gastroparesis patients. Fibrosis was present in the inner circular layer in 13 diabetic and 15 idiopathics and in the outer longitudinal layer in 46 diabetic and 51 idiopathics. Diabetic gastroparesis had less ganglion cells (3.27±1.82 vs 4.81±2.81/hpf; P<.01) and less ganglia (0.90±0.44 vs 1.10±0.50/hpf; P=.01) than idiopathic gastroparesis. Interstitial cells of Cajal (ICC) count was slightly lower in the inner circular layer in diabetic than idiopathics (2.77±1.47 vs 3.18±1.34/hpf; P=.08). Delayed gastric emptying was associated with reduced ICCs in the myenteric plexus. Global therapeutic response to gastric electric stimulation was inversely related to ganglia/hpf (R=-.22; P=.008). In diabetics, improvements in nausea, vomiting, and abdominal pain were inversely related to fibrosis.
  
  
  CONCLUSIONS
  Histologic assessment of full thickness gastric biopsy specimens allows correlation of histopathology to the gastroparesis disease process, its etiology, gastric emptying, and response to gastric electric stimulation treatment.
authors.affiliation: GI Section, Department of Pathology, Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Heckert
authors.affiliation: GI Section, Department of Pathology, Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Thomas
authors.affiliation: GI Section, Department of Pathology, Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: H P
authors.identifier: http://orcid.org/0000-0003-4904-4891
authors.initials: HP
authors.lastname: Parkman
mesh_terms: D000328:Adult; D004599:Electric Stimulation Therapy; D005260:Female; D005746:Gastric Emptying; D018589:Gastroparesis / Q000209:etiology* / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male
keywords: Enterra; diabetes, idiopathic gastroparesis; gastroparesis