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Gastroparesis pp 73–86Cite as

Pathology of Gastroparesis

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Part of the book series: Clinical Gastroenterology ((CG))

Abstract

While symptoms of gastroparesis are defined, the pathogenesis of this condition is poorly understood. Furthermore, gastric emptying scintigraphy, the gold standard for diagnostic testing, does not correlate with symptom severity. Some patients with the classic constellation of symptoms for gastroparesis have normal or near-normal gastric emptying patterns. Uncertainty of underlying pathophysiology underscores the struggle to develop effective therapies. The inability of the stomach to effectively empty its solid and liquid contents into the duodenum in the absence of a mechanical obstruction defines gastroparesis. Gastric emptying is dependent on well-coordinated efforts by multiple components in the gastric wall. Different cells, structures, and mechanisms are hypothesized to be responsible for gastroparesis. Currently, however there is a lack of histopathologic evidence to substantiate most of these hypotheses.

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References

  1. Parkman HP, Hasler WL, Fisher RS. American gastroenterological association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology. 2004;127:1592–622.

    Article  PubMed  Google Scholar 

  2. Lartigue S et al. Inter- and intrasubject variability of solid and liquid gastric emptying parameters. A scintigraphy study in healthy subjects and diabetic patients. Dig Dis Sci. 1994;39:109–15.

    Article  PubMed  CAS  Google Scholar 

  3. Grundy G. Signaling the state of the digestive tract. Rev Auton Neurosci: Basic Clin. 2006;125:76–80.

    Article  Google Scholar 

  4. Ördög T. Interstitial cells of Cajal in diabetic gastroenteropathy. Rev Article Neurogasteroenterol Motil. 2008;20:8–18.

    Article  Google Scholar 

  5. Ward SM, Sanders KM, Hirst GDS. Role of interstitial cells of Cajal in neural control of gastrointestinal smooth muscles. Neurogasteroenterol Motility. 2004;16 Suppl 1:112–7.

    Article  Google Scholar 

  6. Iwakiri R, Fujimoto K. Diabetic gastropathy and interstitial cells of Cajal: a clue for bringing understanding out of chaos? Editorial. J Gastroenterol. 2006;41:1128–30.

    Article  PubMed  Google Scholar 

  7. Shah V, Lyford G, Gores G, Farrugia G. Nitric Oxide in gastrointestinal health and disease. Gastroenterology. 2004;126:903–13.

    Article  PubMed  CAS  Google Scholar 

  8. Takahashi T et al. Impaired expression of nitric oxide synthase in the gastric myenteric plexus of spontaneously diabetic rats. Gastroenterology. 1997;113:1535–44.

    Article  PubMed  CAS  Google Scholar 

  9. Jenkinson KM, Reid JJ. Effect of diabetes on relaxations to non-adrenergic, non-cholinergic nerve stimulation in longitudinal muscle of the rat gastric fundus. Br J Pharmacol. 1995;116:1551–6.

    PubMed  CAS  Google Scholar 

  10. Vittal H, Farrugia G, Gomez G, Pasricha PJ. Mechanisms of disease: the pathological basis of gastroparesis-a review of experimental and clinical studies. Nat Clin Pract Gastroenterol Hepatol. 2007;4:336–46.

    Article  PubMed  CAS  Google Scholar 

  11. Watkins CC et al. Insulin restores neuronal nitric oxide synthase expression and function that is lost in diabetic gastropathy. J Clin Invest. 2000;106:373–84.

    Article  PubMed  CAS  Google Scholar 

  12. Cellek S. Point of NO return for nitrergic nerves in diabetes: a new insight into diabetic complications. Curr Pharm Des. 2004;10:3683–95.

    Article  PubMed  CAS  Google Scholar 

  13. Ördög T, Takayama I, Cheung WK, Ward SM, Sanders KM. Remodeling of networks of interstitial cells of Cajal in a murine model of diabetic gastroparesis. Diabetes. 2000;49:1731–9.

    Article  Google Scholar 

  14. Horvath VJ, Vittal H, Lorincz A, et al. Reduced stem cell factor links smooth myopathy and loss of interstitial cells of Cajal in murine diabetic gastroparesis. Gastroenterology. 2006;130:759–70.

    Article  PubMed  CAS  Google Scholar 

  15. Wang XY, Huizinga JD, Diamond J, Liu JWC. Loss of intramuscular interstitial cells of Cajal and enteric nerves in streptozotocin-induced diabetic rat stomach. Neurogastroenterol Motil. 2006;18:758.

    Article  Google Scholar 

  16. Horvath VJ et al. Reduced insulin and IGF-1 signaling, not hyperglycemia underlies the diabetes-associated depletion of interstitial cells of Cajal in the murine stomach. Diabetes. 2005;54:1528–33.

    Article  PubMed  CAS  Google Scholar 

  17. Guo C et al. Diabetic autonomic neuropathy: evidence for apoptosis in situ in the rat. Neurogastroenterol Motil. 2004;16:335–45.

    Article  PubMed  CAS  Google Scholar 

  18. Tay SS, Wong WC. Short and long-term effects of streptozotocin-induced diabetes on the dorsal motor nucleus of the vagus nerve in the rat. Acta Anat. 1994;150:274–81.

    Article  PubMed  CAS  Google Scholar 

  19. Schmidt RE et al. Analysis of the Zucker diabetic fatty (ZDF) type 2 diabetic rat model suggests a neurotropic role for insulin/IGF-1 in diabetic autonomic neuropathy. Amer J Pathol. 2003;163:21–8.

    Article  CAS  Google Scholar 

  20. Ordog T, Baldo M, Danko R, Sanders KM. Plasticity of electrical pacemaking by interstitial cells of Cajal and gastric dysrhythmias in W/W mutant mice. Gastroenterology. 2002;123:2028–40.

    Article  PubMed  Google Scholar 

  21. Harberson J, Thomas RM, Harbison SP, Parkman HP. Gastric neuromuscular pathology in gastroparesis: analysis of full-thickness antral biopsies. Dig Dis Sci. 2010;55(2):359–70.

    Article  PubMed  Google Scholar 

  22. McCallum RW, Lin Z, Damjanov I, Sarosiek I, Forster J. Interstitial cells of Cajal in the stomach of patients with gastroparesis. Neurogastroenterol Motil. 2006;18:758.

    Article  Google Scholar 

  23. Iwasaki H, Kajimura M, Osawa S, et al. A deficiency of gastric interstitial cells of Cajal accompanied by decreased expression of neuronal nitric oxide synthase and substance P in patients with type 2 diabetes mellitus. J Gastroenterol. 2006;41:1076–87.

    Article  PubMed  CAS  Google Scholar 

  24. Parkman HP et al. American Gastroenterological Association medical position statement: diagnosis and treatment of gastroparesis. Gastroenterology. 2004;127:1589–91.

    Article  PubMed  Google Scholar 

  25. Maleki D et al. Gastrointestinal tract symptoms among persons with diabetes mellitus in the community. Arch Intern Med. 2000;160:2808–16.

    Article  PubMed  CAS  Google Scholar 

  26. Pasricha PJ, Pehlivanov ND, Gomez G, Vittal H. Changes in the gastric enteric nervous system and muscle: a case report on two patients with diabetic gastroparesis. BMC Gastroenterol. 2008;8:21–9.

    Article  PubMed  Google Scholar 

  27. Anvari M et al. Role of nitric oxide mechanisms in control of pyloric motility and transpyloric flow of liquids in conscious dogs. Dig Dis Sci. 1998;43:506–12.

    Article  PubMed  CAS  Google Scholar 

  28. Spiller RC. Infection, immune function and functional gut disorders. Clin Gastroenterol Hepatol. 2004;2:445–55.

    Article  PubMed  Google Scholar 

  29. De Giorgio R, Barbara G, Stanghallini V, et al. Idiopathic myenteric ganglionitis underlying intractable vomiting in a young man. Eur J Gastroent Hepatol. 2000;12:613–6.

    Article  Google Scholar 

  30. Battaglia E, Bassotti G, Bellone G, Dughera L, Serra AM, Chiusa L, et al. Loss of interstitial cells of Cajal in severe idiopathic gastroparesis. W J Gastroenterol. 2006;12:6172–7.

    Google Scholar 

  31. Zarate N, Mearin F, Wang XY, Hewlett B, Huizinga JD, Malagelada JR. Severe idiopathic gastroparesis due to neuronal and interstitial cells of Cajal degeneration: pathological findings and management. Gut. 2003;52:966–70.

    Article  PubMed  CAS  Google Scholar 

  32. Pardi DS, Miller SM, Miller DL, et al. Paraneoplastic dysmotility: loss of interstitial cells of Cajal. Am J Gastroenterol. 2002;97:1828–33.

    Article  PubMed  Google Scholar 

  33. Sigurdsson L, Flores A, Putnam PE, Hyman PE, Di Lorenzo C. Post-viral gastroparesis: ­presentation, treatment and outcome. J Pediatr. 1997;131:751–4.

    Article  PubMed  CAS  Google Scholar 

  34. Pande H, Lacy BE, Crowell MD. Inflammatory causes of gastroparesis. Report of 5 cases. Dig Dis Sci. 2002;47:2664–8.

    Article  PubMed  CAS  Google Scholar 

  35. Bush TG, Savidge TC, Freeman TC, et al. Fulminant jejuno-ileitis following ablation of enteric glia in adult transgenic mice. Cell. 1998;93:189–201.

    Article  PubMed  CAS  Google Scholar 

  36. Cornet A, Savidge TC, Cabarrocas J, et al. Enterocolitis induced by autoimmune targeting of enteric glial cells: a possible mechanism in Crohn’s disease? Proc Natl Acad Sci. 2001;98:13306–11.

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Internal Medicine, Temple University Hospital, Philadelphia, PA, USA

    Amol Sharma MD, MS (Resident Physician)

  2. Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia, PA, USA

    Rebecca Thomas MBB (Professor and Director of Surgical Pathology)

Authors
  1. Amol Sharma MD, MS
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  2. Rebecca Thomas MBB
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Correspondence to Rebecca Thomas MBB .

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Editors and Affiliations

  1. School of Medicine, Department of Medicine, Temple University, N. Broad St. 3401, Philadelphia, 19140, Pennsylvania, USA

    Henry P. Parkman

  2. Paul L Foster School of Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Ce, Alberta Avenue 4800, El Paso, 77905, Texas, USA

    Richard W. McCallum

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Sharma, A., Thomas, R. (2012). Pathology of Gastroparesis. In: Parkman, H., McCallum, R. (eds) Gastroparesis. Clinical Gastroenterology. Humana Press. https://doi.org/10.1007/978-1-60761-552-1_7

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  • DOI: https://doi.org/10.1007/978-1-60761-552-1_7

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  • Publisher Name: Humana Press

  • Print ISBN: 978-1-60761-551-4

  • Online ISBN: 978-1-60761-552-1

  • eBook Packages: MedicineMedicine (R0)

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