Shafik Ahmed, Ahmed Ismail, El Sibai Olfat, Shafik Ali A
Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo, Egypt.
Med Sci Monit. 2005 Dec;11(12):BR452-6. Epub 2005 Nov 24.
Interstitial cells of Cajal (ICCs) are claimed to be involved in gut electromotor activity. We investigated whether absent or diminished ICCs in the esophagogastric junction (EGJ) may be responsible for EGJ incompetence in gastro-esophageal reflux disease (GERD).
MATERIAL/METHODS: Endoscopic specimens were obtained from the upper and mid third of the esophagus and from the EGJ of 29 patients (17 men, 12 women, mean age: 46.7 years) with GERD (5 grade A, 5 B, 6 C, and 13 D, Los Angeles classification) and from 8 controls. Sections were prepared for inmunohistochemical investigation using an ICC marker c-kit. Controls had normal rabbit serum substituted for the primary antiserum.
C-kit-positive branched ICC-like cells were detected in the esophageal and EGJ musculature of the controls. They were distinguishable from the c-kit-negative unbranched smooth muscle cells and from the c-kit-positive unbranched mast cells. Immunoreactivity was absent in the negative controls. ICCs in the esophageal body existed in GERD and in controls, but were absent from the EGJ of 12 patients (2 grade C, 10 D) and occasionally detected in 5 of group A, 5 of B, 4 of C, and 3 of group D patients.
ICCs were demonstrated in the esophageal body and EGJ of controls. In GERD patients they were detected in the esophageal body, but were deficient or absent in the EGJ. It is postulated that ICC absence or deficiency is responsible for EGJ incompetence and GER. The cause of ICC deficiency or absence needs to be investigated.
有人认为 Cajal 间质细胞（ICCs）参与肠道电运动活动。我们研究了食管胃交界处（EGJ）中 ICCs 的缺失或减少是否可能导致胃食管反流病（GERD）中的 EGJ 功能不全。
材料/方法：从 29 例 GERD 患者（17 例男性，12 例女性，平均年龄：46.7 岁，洛杉矶分类：5 例 A 级，5 例 B 级，6 例 C 级，13 例 D 级）的食管上三分之一和中三分之一以及 EGJ 处获取内镜标本，并从 8 例对照者获取标本。使用 ICC 标志物 c-kit 制备切片用于免疫组织化学研究。对照者用正常兔血清替代一抗血清。
在对照者的食管和 EGJ 肌肉组织中检测到 c-kit 阳性的分支状 ICC 样细胞。它们与 c-kit 阴性的无分支平滑肌细胞以及 c-kit 阳性的无分支肥大细胞不同。阴性对照中无免疫反应性。GERD 患者和对照者食管体部均存在 ICCs，但 12 例患者（2 例 C 级，10 例 D 级）的 EGJ 处无 ICCs，A 组 5 例、B 组 5 例、C 组 4 例和 D 组 3 例患者的 EGJ 处偶尔检测到 ICCs。
对照者的食管体部和 EGJ 处证实有 ICCs。GERD 患者食管体部可检测到 ICCs，但 EGJ 处 ICCs 缺乏或缺失。据推测，ICCs 的缺失或缺乏是导致 EGJ 功能不全和 GER 的原因。ICCs 缺乏或缺失的原因有待研究。
