Bashashati Mohammad, Moraveji Sharareh, Torabi Alireza, Sarosiek Irene, Davis Brian R, Diaz Jesus, McCallum Richard W
Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, 4800 Alberta Avenue, El Paso, TX, 79905, USA.
Department of Pathology, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, TX, USA.
Dig Dis Sci. 2017 Oct;62(10):2828-2833. doi: 10.1007/s10620-017-4629-4. Epub 2017 Jun 2.
Gastroparesis (GP)-like syndrome presents with the symptoms of GP but without delayed gastric emptying (GE). Whether GP-like syndrome is part of a spectrum of GP is not clear. This study aimed to compare the histopathological features of antral and pyloric smooth muscle tissue in GP and GP-like syndrome.
Full-thickness antral and/or pyloric biopsies were obtained from 37 GP and 18 GP-like syndrome patients who underwent abdominal surgery to place a gastric electrical stimulator or jejunal feeding tube and/or pyloroplasty. The tissues were stained with H&E, C-Kit, and trichrome. Based on previous control data, an interstitial cells of Cajal (ICC) count of <10 per high power field in the antrum and/or pylorus was considered depletion. Baseline total symptom score (TSS) was recorded.
Twenty-four GP and 7 GP-like patients had pyloric biopsies. Pyloric ICC loss was observed in 20/24 (83.3%) GP and 2/7 (28.6%) GP-like patients (p < 0.01). Fibrosis was detected in the pyloric tissue of 20/24 (83.3%) GP and 2/7 (28.6%) GP-like patients who had pyloric trichrome staining (p < 0.01). Seventeen out of 24 (70.8%) GP patients with pyloric biopsies had concomitant pyloric ICC loss and fibrosis, while only one GP-like patient had ICC loss and simultaneous pyloric fibrosis. GP patients had a greater TSS compared to GP-like patients. In GP patients, those with pyloric ICC loss had a greater TSS compared to those with normal ICC. GP patients with pyloric fibrosis had a higher TSS compared to those without pyloric fibrosis.
Compared to GP-like patients, the pyloric histopathological findings of ICC loss and fibrosis are common in GP and predict a greater symptom score. These pathological findings might be considered as markers of "pyloric dysfunction" and explain delayed GE in GP.
胃轻瘫（GP）样综合征表现出胃轻瘫的症状，但无胃排空延迟（GE）。GP样综合征是否为胃轻瘫谱系的一部分尚不清楚。本研究旨在比较胃轻瘫和胃轻瘫样综合征患者胃窦和幽门平滑肌组织的组织病理学特征。
对37例胃轻瘫患者和18例胃轻瘫样综合征患者进行全层胃窦和/或幽门活检，这些患者接受了腹部手术以植入胃电刺激器或空肠喂养管和/或幽门成形术。组织用苏木精-伊红（H&E）、C-Kit和三色染色。根据先前的对照数据，胃窦和/或幽门每高倍视野中 Cajal间质细胞（ICC）计数<10被认为是缺失。记录基线总症状评分（TSS）。
24例胃轻瘫患者和7例胃轻瘫样患者进行了幽门活检。在20/24（83.3%）的胃轻瘫患者和2/7（28.6%）的胃轻瘫样患者中观察到幽门ICC缺失（p<0.01）。在进行幽门三色染色的20/24（83.3%）的胃轻瘫患者和2/7（28.6%）的胃轻瘫样患者的幽门组织中检测到纤维化（p<0.01）。24例进行幽门活检的胃轻瘫患者中有17例（70.8%）同时存在幽门ICC缺失和纤维化，而只有1例胃轻瘫样患者有ICC缺失和同时存在的幽门纤维化。与胃轻瘫样患者相比，胃轻瘫患者的TSS更高。在胃轻瘫患者中，幽门ICC缺失的患者比ICC正常的患者TSS更高。有幽门纤维化的胃轻瘫患者比没有幽门纤维化的患者TSS更高。
与胃轻瘫样患者相比，胃轻瘫患者中幽门ICC缺失和纤维化的组织病理学发现很常见，并且预示着更高的症状评分。这些病理发现可能被视为“幽门功能障碍”的标志物，并解释胃轻瘫患者的胃排空延迟。
