Acta Neuropathologica

, Volume 118, Issue 2, pp 271–301 | Cite as

Gastrointestinal neuromuscular pathology: guidelines for histological techniques and reporting on behalf of the Gastro 2009 International Working Group

  • Charles H. KnowlesEmail author
  • Roberto De Giorgio
  • Raj P. Kapur
  • Elisabeth Bruder
  • Gianrico Farrugia
  • Karel Geboes
  • Michael D. Gershon
  • John Hutson
  • Greger Lindberg
  • Joanne E. Martin
  • William A. Meier-Ruge
  • Peter J. Milla
  • Virpi V. Smith
  • Jean Marie Vandervinden
  • Béla Veress
  • Thilo Wedel
Consensus Paper


The term gastrointestinal neuromuscular disease describes a clinically heterogeneous group of disorders of children and adults in which symptoms are presumed or proven to arise as a result of neuromuscular, including interstitial cell of Cajal, dysfunction. Such disorders commonly have impaired motor activity, i.e. slowed or obstructed transit with radiological evidence of transient or persistent visceral dilatation. Whilst sensorimotor abnormalities have been demonstrated by a variety of methods in these conditions, standards for histopathological reporting remain relatively neglected. Significant differences in methodologies and expertise continue to confound the reliable delineation of normality and specificity of particular pathological changes for disease. Such issues require urgent clarification to standardize acquisition and handling of tissue specimens, interpretation of findings and make informed decisions on risk-benefit of full-thickness tissue biopsy of bowel or other diagnostic procedures. Such information will also allow increased certainty of diagnosis, facilitating factual discussion between patients and caregivers, as well as giving prognostic and therapeutic information. The following report, produced by an international working group, using established consensus methodology, presents proposed guidelines on histological techniques and reporting for adult and paediatric gastrointestinal neuromuscular pathology. The report addresses the main areas of histopathological practice as confronted by the pathologist, including suction rectal biopsy and full-thickness tissue obtained with diagnostic or therapeutic intent. For each, indications, safe acquisition of tissue, histological techniques, reporting and referral recommendations are presented.


Enteric neuropathy Enteric myopathy Interstitial cells of Cajal Histopathology Hirschsprung disease Suction rectal biopsy Intestinal pseudo-obstruction 





Chronic intestinal pseudo-obstruction


Gastrointestinal neuromuscular disease


Gastrointestinal neuromuscular pathology


Haematoxylin and eosin


Hirschsprung disease


Irritable bowel syndrome


Interstitial cells of Cajal


Intraepithelial lymphocytes




Intestinal neuronal dysplasia


International working group


Natural orifice transluminal endoscopic surgery


Neuron specific enolase


Periodic acid-Schiff

PGP 9.5

Protein gene product 9.5


Suction rectal biopsy


Transmission electron microscopy



This project is supported by an award from Gastro 2009 on behalf of co-operating societies (United European Gastroenterology Federation [UEGF], World Gastroenterology Organization [WGO], British Society of Gastroenterology [BSG], Organisation Mondiale d’Endoscopie Digestive [OMED]). We should also like to thank Professors Colin Rudolph and Jan Huizinga for general guidance, and Doctor Sean Ward for assistance with the ICC section.

Conflict of interest statement

All authors declare that they have no conflict of interest.

Supplementary material

401_2009_527_MOESM1_ESM.doc (41 kb)
Supplementary material (DOC 41 kb)
401_2009_527_MOESM2_ESM.ppt (2 mb)
Supplementary material (PPT 2.01 Mb)


  1. 1.
    Akbar A, Yiangou Y, Facer P, Walters JR, Anand P, Ghosh S (2008) Increased capsaicin receptor TRPV1 expressing sensory fibres in irritable bowel syndrome and their correlation with abdominal pain. Gut 57:923–929. doi: 10.1136/gut.2007.138982 PubMedGoogle Scholar
  2. 2.
    Aldridge RT, Campbell PE (1968) Ganglion cell distribution in the normal rectum and anal canal. A basis for the diagnosis of Hirschsprung’s disease by anorectal biopsy. J Pediatr Surg 3:475–489. doi: 10.1016/0022-3468(68)90670-2 PubMedGoogle Scholar
  3. 3.
    Alizai NK, Batcup G, Dixon MF, Stringer MD (1998) Rectal biopsy for Hirschsprung’s disease: what is the optimum method. Pediatr Surg Int 13:121–124. doi: 10.1007/s003830050264 PubMedGoogle Scholar
  4. 4.
    Arista Nasr J, Gonzalez-Romo M, Keirns C, Larriva-Sahd J (1993) Diffuse lymphocytic infiltration of the small intestine with damage to the nerve plexus. Arch Pathol Lab Med 117:812–819PubMedGoogle Scholar
  5. 5.
    Ariza A, Coll J, Fernandez-Figueras MT et al (1995) Desmin myopathy: a multisystem disorder involving skeletal, cardiac and smooth muscle. Hum Pathol 26:1032–1037. doi: 10.1016/0046-8177(95)90095-0 PubMedGoogle Scholar
  6. 6.
    Athow AC, Filipe MI, Drake DP (1990) Problems and advantages of acetylcholinesterase histochemistry of rectal suction biopsies in the diagnosis of Hirschsprung’s disease. J Pediatr Surg 25:520–526. doi: 10.1016/0022-3468(90)90564-P PubMedGoogle Scholar
  7. 7.
    Attwood SE, Kelly I, O’Connell PR, Corrigan T (1993) Laparoscopic mobilization and exteriorization for minimally invasive small bowel resection. Br J Surg 80:225. doi: 10.1002/bjs.1800800235 PubMedGoogle Scholar
  8. 8.
    Barbara G, De Giorgio R, Stanghellini V, Cremon C, Corinaldesi R (2002) A role for inflammation in irritable bowel syndrome? Gut 51(Suppl 1):i41–i44. doi: 10.1136/gut.51.suppl_1.i41 PubMedGoogle Scholar
  9. 9.
    Barbara G, Stanghellini V, De Giorgio R, Cremon C, Cottrell GS, Santini D et al (2004) Activated mast cells in proximity to olonic nerves correlate with abdominal pain in irritable bowel syndrome. Gastroenterology 126:693–702. doi: 10.1053/j.gastro.2003.11.055 PubMedGoogle Scholar
  10. 10.
    Barbara G, Wang B, Stanghellini V, De Giorgio R, Cremon C, Di Nardo G et al (2007) Mast cell-dependent excitation of visceral nociceptive sensory neurons in irritable bowel syndrome. Gastroenterology 132:26–37. doi: 10.1053/j.gastro.2006.11.039 PubMedGoogle Scholar
  11. 11.
    Barnett JL, McDonnell WM, Appelman HD, Dobbins WO (2004) Familial visceral neuropathy with neuronal intranuclear inclusions: diagnosis by rectal biopsy. Gastroenterology 102:684–691Google Scholar
  12. 12.
    Barshack I, Fridman E, Goldberg I, Chowers Y, Koplovic J (2004) The loss of calretinin expression indicates aganglionosis in Hirschsprung’s disease. J Clin Pathol 57:712–716. doi: 10.1136/jcp.2004.016030 PubMedGoogle Scholar
  13. 13.
    Bassotti G, Villanacci V, Cathomas G, Maurer CA, Fisogni S, Cadei M (2006) Enteric neuropathology of the terminal ileum in patients with intractable slow-transit constipation. Hum Pathol 37:1252–1258. doi: 10.1016/j.humpath.2006.04.027 PubMedGoogle Scholar
  14. 14.
    Boman F, Sfeir R, Priso R, Bonnevalle M, Besson R (2007) Advantages of intraoperative semiquantitative evaluation of myenteric nervous plexuses in patients with Hirschsprung disease. J Pediatr Surg 42:1089–1094. doi: 10.1016/j.jpedsurg.2007.01.052 PubMedGoogle Scholar
  15. 15.
    Borchard F, Meier-Ruge W, Wiebecke B et al (1991) Innervationsstörungen des Dickdarms–Klassifikation und Diagnostik. Pathologe 12:171–174PubMedGoogle Scholar
  16. 16.
    Brittingham J, Phiel C, Trzyna WC, Gabbeta V, McHugh KM (1998) Identification of distinct molecular phenotypes in cultured gastrointestinal smooth muscle cells. Gastroenterology 115:605–617. doi: 10.1016/S0016-5085(98)70140-4 PubMedGoogle Scholar
  17. 17.
    Bruder E, Knecht Y, Kasper M, Chaffard R, Ipsen S, Terracciano L et al (2007) Enzyme histochemical diagnosis of gastrointestinal motility disorders. A Laboratory guide. Pathologie 28:93–100. doi: 10.1007/s00292-007-0902-1 Google Scholar
  18. 18.
    Bughaighis AG, Emery JL (1971) Functional obstruction of the intestine due to neurological immaturity. Prog Pediatr Surg 3:37–52PubMedGoogle Scholar
  19. 19.
    Camilleri M, Cowen T, Koch TR (2008) Enteric neurodegeneration in ageing. Neurogastroenterol Motil 20:418–429. doi: 10.1111/j.1365-2982.2008.01134.x PubMedGoogle Scholar
  20. 20.
    Cellek S, Foxwell NA, Moncada S (2003) Two phases of nitrergic neuropathy in streptozotocin-induced diabetic rats. Diabetes 52:2353–2362. doi: 10.2337/diabetes.52.9.2353 PubMedGoogle Scholar
  21. 21.
    Chadwick VS, Chen W, Shu D, Paulus B, Bethwaite P, Tie A et al (2002) Activation of the mucosal immune system in irritable bowel syndrome. Gastroenterology 122:1778–1783. doi: 10.1053/gast.2002.33579 PubMedGoogle Scholar
  22. 22.
    Chang F, Mahadeva U, Deere H (2005) Pathological and clinical significance of increased intraepithelial lymphocytes (IELs) in small bowel mucosa. APMIS 113:385–399. doi: 10.1111/j.1600-0463.2005.apm_204.x PubMedGoogle Scholar
  23. 23.
    Clark SB, Rice TW, Tubbs RR, Richter JE, Goldblum JR (2000) The nature of the myenteric infiltrate in achalasia: an immunohistochemical analysis. Am J Surg Pathol 24:1153–1158. doi: 10.1097/00000478-200008000-00014 PubMedGoogle Scholar
  24. 24.
    Coerdt W, Michel J-S, Rippin G et al (2004) Quantitative morphometric analysis of the submucous plexus in age-related control groups. Virchows Arch 444:239–246. doi: 10.1007/s00428-003-0951-7 PubMedGoogle Scholar
  25. 25.
    Cord-Udy C, Smith VV, Ahmed S, Milla PJ, Risdon RA (1997) An evaluation of the role of suction rectal biopsy in the diagnosis of intestinal neuronal dysplasia. J Pediatr Gastroenterol Nutr 24:1–6. doi: 10.1097/00005176-199701000-00002 PubMedGoogle Scholar
  26. 26.
    Csendes A, Smok G, Braghetto I et al (1992) Histological studies of Auerbach’ plexuses of the oesophagus, stomach, jejunum, and colon in patients with achalasia of the oesophagus: correlation with gastric acid secretion, presence of parietal cells and gastric emptying of solids. Gut 33:150–154. doi: 10.1136/gut.33.2.150 PubMedGoogle Scholar
  27. 27.
    Danesh BJZ, Burke M, Newman J, Aylott A, Whitfield P, Cotton PR (1985) Comparison of weight, depth and diagnostic adequacy of specimens obtained with 16 different biopsy forceps designed for upper gastrointestinal endoscopy. Gut 26:227–231. doi: 10.1136/gut.26.3.227 PubMedGoogle Scholar
  28. 28.
    De Giorgio R, Barbara G (2008) Is irritable bowel syndrome an inflammatory disorder? Curr Gastroenterol Rep 10:385–390. doi: 10.1007/s11894-008-0073-0 PubMedGoogle Scholar
  29. 29.
    De Giorgio R, Barbara G, Stanghellini V, Cogliandro RF, Arrigoni A, Santini D (2000) Idiopathic myenteric ganglionitis underlying intractable vomiting in a young adult. Eur J Gastroenterol Hepatol 12:613–616. doi: 10.1097/00042737-200012060-00006 PubMedGoogle Scholar
  30. 30.
    De Giorgio R, Barbara G, Stanghellini V, De Ponti F, Salvioli B, Tonini M et al (2002) Clinical and morphofunctional features of idiopathic myenteric ganglionitis underlying severe intestinal motor dysfunction: a study of three cases. Am J Gastroenterol 97:2454–2459. doi: 10.1016/S0002-9270(02)04359-9 PubMedGoogle Scholar
  31. 31.
    De Giorgio R, Guerrini S, Barbara G, Cremon C, Stanghellini V, Corinaldesi R (2004) New insights into human enteric neuropathies. Neurogastroenterol Motil 16(suppl 1):143–147. doi: 10.1111/j.1743-3150.2004.00491.x PubMedGoogle Scholar
  32. 32.
    De Giorgio R, Sarnelli G, Corinaldesi R, Stanghellini V (2004) Advance in our understanding of the pathology of chronic intestinal pseudo-obstruction. Gut 53:1549–1552. doi: 10.1136/gut.2004.043968 PubMedGoogle Scholar
  33. 33.
    DeSchryver-Kecskemeti K, Clouse RE (1989) Perineural and intraneural inflammatory infiltrates in the intestines of patients with systemic connective-tissue disease. Arch Pathol Lab Med 113:394–398PubMedGoogle Scholar
  34. 34.
    de Souza RR, Moratelli HB, Borges N, Liberti EA (1993) Age-induced nerve cell loss in the myenteric plexus of the small intestine in man. Gerontology 39:183–188PubMedCrossRefGoogle Scholar
  35. 35.
    Dobbins WO, Bill AH (1965) Diagnosis of Hirschsprung’s disease excluded by rectal suction biopsy. N Engl J Med 272:990–993PubMedGoogle Scholar
  36. 36.
    Drossman DA (2007) Introduction. The Rome Foundation and Rome III. Neurogastroenterol Motil 19:783–786. doi: 10.1111/j.1365-2982.2007.01001.x PubMedGoogle Scholar
  37. 37.
    Duchen LW, Anjorin A, Watkins PJ, Mackay JD (1980) Pathology of autonomic neuropathy in diabetes mellitus. Ann Intern Med 92:301–303PubMedGoogle Scholar
  38. 38.
    Dvorak AM, Onderdonk AB, McLeod RS et al (1993) Axonal necrosis of enteric autonomic nerves in continent ileal pouches. Possible implications for pathogenesis of Crohn’s disease. Ann Surg 217:260–271. doi: 10.1097/00000658-199303000-00008 PubMedGoogle Scholar
  39. 39.
    Dvorak AM, Osage JE, Monahan RA, Dickersin GR (1980) Crohns’s disease: transmission electron microscopic studies. III. Target tissues. Proliferation and injury to smooth muscle cells and the autonomic nervous system. Hum Pathol 11:620–634. doi: 10.1016/S0046-8177(80)80073-6 PubMedGoogle Scholar
  40. 40.
    Dyer NH, Dawson AM, Smith BF, Todd IP (1969) Obstruction of the bowel due to a lesion in the myenteric plexus. BMJ I:686–689Google Scholar
  41. 41.
    Ehrenpreis T (1966) Seminar on Pseudo-Hirschsprung’s disease and related disorders. Arch Dis Child 41:143–154. doi: 10.1136/adc.41.216.137 Google Scholar
  42. 42.
    Ellison D, Love S, Chimelli L et al (1998) Neuropathology. A reference text of CNS pathology. C. V. Mosby Co., St. Louis, pp 1.1–1.18Google Scholar
  43. 43.
    Eltringham WK, Roe AM, Galloway SW et al (1993) A laparoscopic technique for full-thickness intestinal biopsy and feeding jejunostomy. Gut 34:122–124. doi: 10.1136/gut.34.1.122 PubMedGoogle Scholar
  44. 44.
    Emery JL (1973) Colonic retention syndrome (megacolon) associated with immaturity of intestinal intramural plexus. Proc R Soc Med 66:222–223PubMedGoogle Scholar
  45. 45.
    Erdohazi M (1974) Retarded development of the enteric myenteric plexus. Dev Med Child Neurol 16:365–368PubMedGoogle Scholar
  46. 46.
    Espinosa I, Lee CH, Kim MK, Rouse BT, Subramanian S, Montomery K et al (2008) A novel monoclonal antibody against DOG1 is a sensitive and specific marker for gastrointestinal stromal tumors. Am J Surg Pathol 32:210–218. doi: 10.1097/PAS.0b013e3181238cec PubMedGoogle Scholar
  47. 47.
    Facer P, Knowles CH, Thomas PK, Tam PK, Williams NS, Anand P (2001) Decreased tyrosine kinase C expression may reflect developmental abnormalities in Hirschsprung’s disease and idiopathic slow-transit constipation. Br J Surg 88:545–552. doi: 10.1046/j.1365-2168.2001.01731.x PubMedGoogle Scholar
  48. 48.
    Farrugia G (2008) Interstitial cells of Cajal in health and disease. Neurogastroenterol Motil 20(Suppl 1):54–63. doi: 10.1111/j.1365-2982.2008.01109.x PubMedGoogle Scholar
  49. 49.
    Faussone-Pellegrini MS, Fociani P, Buffa R, Basilisco G (1999) Loss of interstitial cells and a fibromuscular layer on the luminal side of the colonic circular muscle presenting a megacolon in an adult patient. Gut 45:775–779PubMedGoogle Scholar
  50. 50.
    Fitzgibbons PL, Chandrasoma PT (1987) Familial visceral myopathy. Evidence of diffuse involvement of intestinal smooth muscle. Am J Surg Pathol 11:846–854. doi: 10.1097/00000478-198711000-00003 PubMedGoogle Scholar
  51. 51.
    Forster J, Damjanov I, Lin Z, Sarosiek I, Wetzel P, McCallum RW (2005) Absence of the interstitial cells of Cajal in patients with gastroparesis and correlation with clinical findings. J Gastrointest Surg 9:102–108. doi: 10.1016/j.gassur.2004.10.001 PubMedGoogle Scholar
  52. 52.
    Gabella G (1981) Structure of muscles and nerves in the gastrointestinal tract. In: Johnson LR (ed) Physiology of the Gastrointestinal tract, Chap 6. Raven Press, New York, pp 197–241Google Scholar
  53. 53.
    Ganns D, Schrödl F, Neuhuber W, Brehmer A (2006) Investigation of general and cytoskeletal markers to estimate numbers and proportions of neurons in the human intestine. Histol Histopathol 21:41–51PubMedGoogle Scholar
  54. 54.
    Gattuso JM, Kamm MA (1997) Clinical features of idiopathic megarectum and idiopathic megacolon. Gut 41:93–99PubMedGoogle Scholar
  55. 55.
    Gattuso JM, Smith VV, Kamm MA (1998) Altered contractile proteins and neural innervation in idiopathic megarectum and megacolon. Histopathology 33:34–38. doi: 10.1046/j.1365-2559.1998.00438.x PubMedGoogle Scholar
  56. 56.
    Giniès JL, François H, Joseph MG, Champion G, Coupris L, Limal JM (1996) A curable cause of chronic idiopathic intestinal pseudo-obstruction in children: idiopathic myositis of the small intestine. J Pediatr Gastroenterol Nutr 23:426–429. doi: 10.1097/00005176-199611000-00012 PubMedGoogle Scholar
  57. 57.
    Gladman MA, Knowles CH (2008) Novel concepts in the diagnosis, pathophysiology and management of idiopathic megabowel. Colorectal Dis 10:531–538. doi: 10.1111/j.1463-1318.2007.01457.x PubMedGoogle Scholar
  58. 58.
    Gladman MA, Knowles CH (2008) Surgical treatment of patients with constipation and fecal incontinence. Gastroenterol Clin North Am 37:605–625. doi: 10.1016/j.gtc.2008.06.009 PubMedGoogle Scholar
  59. 59.
    Glia A (1999) Immunohistochemical studies of the small bowel and the colon in patients with slow transit constipation. In: Glia A (ed) Constipation: symptoms and findings in relation to structural and functional abnormalities. Karolinska Institutet, Stockholm.
  60. 60.
    Greig JD, Miles WF, Nixon SJ (1995) Laparoscopic technique for small bowel biopsy. Br J Surg 82:363. doi: 10.1002/bjs.1800820326 PubMedGoogle Scholar
  61. 61.
    Haas S, Bindl L, Fischer HP (2005) Autoimmune enteric leiomyositis: a rare cause of chronic intestinal pseudo-obstruction with specific morphological features. Hum Pathol 36:576–580. doi: 10.1016/j.humpath.2005.01.005 PubMedGoogle Scholar
  62. 62.
    Hayat M, Cairns A, Dixon MF, O’Mahony S (2002) Quantitation of intraepithelial lymphocytes in human duodenum: what is normal? J Clin Pathol 55:393–394PubMedGoogle Scholar
  63. 63.
    He C-L, Burgart L, Wang L et al (2000) Decreased interstitial cell of Cajal volume in patients with slow-transit constipation. Gastroenterology 118:14–21. doi: 10.1016/S0016-5085(00)70409-4 PubMedGoogle Scholar
  64. 64.
    Heneyke S, Smith VV, Spitz L, Milla PJ (1999) Chronic intestinal pseudo-obstruction: treatment and long term follow-up of 44 patients. Arch Dis Child 81:21–27. doi: 10.1136/adc.81.1.21 PubMedGoogle Scholar
  65. 65.
    Herrera GA, Pinto de Moraes H, Grizzle WE, Han SG (1984) Malignant small bowel neoplasm of enteric plexus derivation (plexosarcoma). Light and electron microscopic study confirming the origin of the neoplasm. Dig Dis Sci 29:275–284. doi: 10.1007/BF01296263 PubMedGoogle Scholar
  66. 66.
    Hiatt RB, Katz L (1962) Mast cells in inflammatory conditions of the gastrointestinal tract. Am J Gastroenterol 37:541–545PubMedGoogle Scholar
  67. 67.
    Ho YH, Tan M, Eu KW, Leong A, Choen FS (1997) Laparoscopic-assisted compared with open total colectomy in treating slow transit constipation. Aust N Z J Surg 67:562–565. doi: 10.1111/j.1445-2197.1997.tb02039.x PubMedGoogle Scholar
  68. 68.
    Hoff S, Zeller F, von Weyhern CW, Wegner M, Schemann M, Michel K et al (2008) Quantitative assessment of glial cells in the human and guinea pig enteric nervous system with an anti-Sox8/9/10 antibody. J Comp Neurol 509:356–371. doi: 10.1002/cne.21769 PubMedGoogle Scholar
  69. 69.
    Holschneider AM, Meier-Ruge W, Ure BM (1994) Hirschsprung’s disease and allied disorders–a review. Eur J Pediatr Surg 4:260–266. doi: 10.1055/s-2008-1066115 PubMedGoogle Scholar
  70. 70.
    Hubball A, Martin JE, Lang B, De Giorgio R, Knowles CH (2008) The role of humoral autoimmunity in gastrointestinal neuromuscular diseases. Prog Neurobiol (in press)Google Scholar
  71. 71.
    Hutson JM, Chow CW, Borg J (1996) Intractable constipation with a decrease in Substance P-immunoreactive fibres: is it a variant of intestinal neuronal dysplasia? J Ped Surg 31:580–583. doi: 10.1016/S0022-3468(96)90501-1 Google Scholar
  72. 72.
    Isozaki K, Hirota S, Miyagawa J, Taniguchi M, Shinomura Y, Matsuzawa Y (1997) Deficiency of c-kit + cells in patients with a myopathic form of chronic idiopathic intestinal pseudo-obstruction. Am J Gastroenterol 92:332–334PubMedGoogle Scholar
  73. 73.
    Iwasaki H, Kajimura M, Osawa S, Kanaoka S, Furuta T, Ikuma M et al (2006) 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 41:1076–1087. doi: 10.1007/s00535-006-1909-8 PubMedGoogle Scholar
  74. 74.
    Jacobs E, Ardichvili D, Perissino A, Gottignies P, Hanssens JF (1979) A case of familial visceral myopathy with atrophy and fibrosis of the longitudinal muscle layer of the entire small bowel. Gastroenterology 77:745–750PubMedGoogle Scholar
  75. 75.
    Jenkins D, Goodall A, Drew K, Scott BB (1988) What is colitis? Statistical approach to distinguishing clinically important inflammatory change in rectal biopsy specimens. J Clin Pathol 41:72–79. doi: 10.1136/jcp.41.1.72 PubMedGoogle Scholar
  76. 76.
    Kamiya S, Suzuki Y, Sugimura M (1983) Polyglucosan bodies in the digestive tract of the aged dog. Acta Neuropathol 60:297–300. doi: 10.1007/BF00691880 PubMedGoogle Scholar
  77. 77.
    Kapur RP (2003) Neuronal dysplasia: a controversial pathological correlate of intestinal pseudo-obstruction. Am J Med Genet 122A:287–293. doi: 10.1002/ajmg.a.20470 PubMedGoogle Scholar
  78. 78.
    Kapur RP (2006) Can we stop looking? Immunohistochemistry and the diagnosis of Hirschsprung disease. Am J Clin Pathol 126:9–12. doi: 10.1309/T7REY1N43FML7AA8 PubMedGoogle Scholar
  79. 79.
    Kapur RP, de Sa DJ, Luquette M, Jaffe R (1995) Hypothesis: pathogenesis of skip areas in long-segment Hirschsprung’s disease. Pediatr Pathol Lab Med 15:23–37PubMedGoogle Scholar
  80. 80.
    Kapur RP, Reed RC, Finn L, Patterson K, Johanson J, Rutledge JC (2008) Calretinin immunohistochemistry versus acetylcholinesterase histochemistry in the evaluation of suction rectal biopsies for Hirschsprung disease. Pediatr Dev Pathol (in press)Google Scholar
  81. 81.
    Kashyap P, Farrugia G (2008) Enteric autoantibodies and gut motility disorders. Gastroenterol Clin North Am 37:397–410. doi: 10.1016/j.gtc.2008.02.005 PubMedGoogle Scholar
  82. 82.
    Kenny SE, Vanderwinden JM, Rintala RJ, Connell MG, Lloyd DA, Vanderhaeghen JJ et al (1998) Delayed maturation of the interstitial cells of Cajal: a new diagnosis for transient neonatal pseudoobstruction. Report of two cases. J Pediatr Surg 33:94–98. doi: 10.1016/S0022-3468(98)90370-0 PubMedGoogle Scholar
  83. 83.
    King PH, Redden D, Palmgren JS, Nabors LB, Lennon VA (1999) Hu antigen specificities of ANNA-1 autoantibodies in paraneoplastic neurological disease. J Autoimmun 13:435–443. doi: 10.1006/jaut.1999.0337 PubMedGoogle Scholar
  84. 84.
    King SK, Sutcliffe JR, Hutson JM (2005) Laparoscopic seromuscular colonic biopsies: a surgeon’s experience. J Ped Surg 40:381–384. doi: 10.1016/j.jpedsurg.2004.10.031 Google Scholar
  85. 85.
    Knowles CH (2007) New horizons in the pathogenesis of gastrointestinal neuromuscular disease. J Pediatr Gastroenterol Nutr 45(Suppl 2):S97–S102. doi: 10.1097/MPG.0b013e31812e6569 PubMedGoogle Scholar
  86. 86.
    Knowles CH, De Giorgio R (2008) Observations on a vestigial organ: a potential surrogate for enteric neuromesenchymal disease. Neurogastroenterol Motil 20:263–268. doi: 10.1111/j.1365-2982.2008.01090.x PubMedGoogle Scholar
  87. 87.
    Knowles CH, Martin JE (2000) Slow transit constipation: a model of human gut dysmotility. Review of possible aetiologies. Neurogastroenterol Motil 12:181–196. doi: 10.1046/j.1365-2982.2000.00198.x PubMedGoogle Scholar
  88. 88.
    Knowles CH, Nickols CD, Feakins R, Martin JE (2003) A systematic analysis of polyglucosan bodies in the human gastrointestinal tract in health and disease. Acta Neuropathol 105:410–413PubMedGoogle Scholar
  89. 89.
    Knowles CH, Nickols CD, Scott SM, Bennett NI, de Oliveira RB, Chimelli L et al (2001) Secondary smooth muscle degeneration with inclusion bodies in slow transit constipation. J Pathol 193:390–397. doi: 10.1002/1096-9896(2000)9999:9999<::AID-PATH797>3.0.CO;2-C PubMedGoogle Scholar
  90. 90.
    Knowles CH, Scott M, Lunniss PJ (1999) Outcome of colectomy for slow transit constipation. Ann Surg 230:627–638. doi: 10.1097/00000658-199911000-00004 PubMedGoogle Scholar
  91. 91.
    Knowles CH, Silk DBA, Darzi A, Feakins R, Raimundo AH, Veress B et al (2004) Deranged smooth muscle alpha-actin: a biomarker of intestinal pseudo-obstruction. A controlled multinational case series. Gut 53:1583–1589. doi: 10.1136/gut.2003.037275 PubMedGoogle Scholar
  92. 92.
    Knowles CH, Veress B, Tornblom H, Wallace S, Paraskevas P, Darzi A (2008) Safety and diagnostic yield of laparoscopically assisted full-thickness bowel biopsy. Neurogastroenterol Motil 20:774–779. doi: 10.1111/j.1365-2982.2008.01099.x PubMedGoogle Scholar
  93. 93.
    Koletzko S, Jesch I, Faus-Kebetaler T, Briner J, Meier-Ruge WA, Muntefering H et al (1999) Rectal biopsy for diagnosis of intestinal neuronal dysplasia in children: a prospective multicentre study on interobserver variation and clinical outcome. Gut 44:853–861PubMedCrossRefGoogle Scholar
  94. 94.
    Krishnamurthy S, Heng Y, Schuffler MD (1993) Chronic intestinal pseudo-obstruction in infants and children caused by diverse abnormalities of the myenteric plexus. Gastroenterology 104:1398–1408PubMedGoogle Scholar
  95. 95.
    Krishnamurthy S, Schuffler MD (1987) Pathology of neuromuscular disorders of the small intestine and colon. Gastroenterology 93:610–639PubMedGoogle Scholar
  96. 96.
    Krishmanurthy S, Schuffler MD, Rohrmann CA, Pope CEII (1985) Severe idiopathic constipation is associated with a distinctive abnormality of the colonic myenteric plexus. Gastroenterology 88:26–34Google Scholar
  97. 97.
    Kulikova-Schupak R, Knupp KG, Pascual JM, Chin SS, Kairam R, Patterson MC (2004) Rectal biopsy in the diagnosis of neuronal intranuclear hyaline inclusion disease. J Child Neurol 19:59–62. doi: 10.1177/08830738040190010707 PubMedGoogle Scholar
  98. 98.
    Kumar D, Phillips SF (1989) Human myenteric plexus: confirmation of unfamiliar structures in adults and neonates. Gastroenterology 96:1021–1028PubMedGoogle Scholar
  99. 99.
    Kume M (1971) Personal communication. J Jpn Soc Pediatr Surg 6:479Google Scholar
  100. 100.
    Lake BD, Puri P, Nixon HH, Claireaux AE (1978) Hirschsprung’s disease: an appraisal of histochemically demonstrated acetylcholinesterase activity in suction rectal biopsy specimens as an aid to diagnosis. Arch Pathol Lab Med 102:244–247PubMedGoogle Scholar
  101. 101.
    Lazenby AJ, Yardley JH, Giardiello FM, Jessurun J, Bayless TM (1989) Lymphocytic (“microscopic”) colitis: a comparative histopathologic study with particular reference to collagenous colitis. Hum Pathol 20:18–28. doi: 10.1016/0046-8177(89)90198-6 PubMedGoogle Scholar
  102. 102.
    Lee J, Ip W, Durie P (1997) Is fibrosing colonopathy an immune mediated disease? Arch Dis Child 77:66–70. doi: 10.1136/adc.77.1.66 PubMedGoogle Scholar
  103. 103.
    Liddell RA, Syms M, McHugh KM (1993) Heterogeneous isoactin gene expression in the adult rat gastrointestinal tract. Gastroenterology 105:347–356PubMedGoogle Scholar
  104. 104.
    Lyford GL HECL, Soffer HE, Hull TL, Strong SA, Senagore AJ et al (2002) Pan-colonic decrease in interstitial cells of Cajal in patients with slow transit constipation. Gut 51:495–496. doi: 10.1136/gut.51.4.496 Google Scholar
  105. 105.
    Mainguet P, Jouret A (1996) The collaboration between the endoscopist and the pathologist. Acta Endoscopica 26:67–77. doi: 10.1007/BF02965791 Google Scholar
  106. 106.
    Mann SD, Debinski HS, Kamm MA (1997) Clinical characteristics of chronic idiopathic intestinal pseudo-obstruction in adults. Gut 41:675–681PubMedCrossRefGoogle Scholar
  107. 107.
    Martin JE, Hester TW, Aslam H, Sinha S, Knowles CH (2008) Discordant practice and limited histopathological assessment in gastrointestinal neuromuscular disease. Gut (submitted)Google Scholar
  108. 108.
    Martin JE, Smith VV, Domizio P (1999) Myopathies of the gastro-intestinal tract. In: Lowe J, Underwood JC (eds) Recent Advances in Histopathology 18. Churchill Livingstone, Edinburgh, pp 43–62Google Scholar
  109. 109.
    McDonald GB, Schuffler MD, Kadin ME, Tytgat GNJ (1985) Intestinal pseudoobstruction caused by diffuse lymphoid infiltration of the small intestine. Gastroenterology 89:882–889PubMedGoogle Scholar
  110. 110.
    Meier-Ruge W (1971) Über en Erkrankungsbild des Colon mit Hirschsprung-symptomatik. Verh Dtsch Ges Pathol 55:506–510PubMedGoogle Scholar
  111. 111.
    Meier-Ruge W, Bruder E (2005) Pathology of chronic constipation in pediatric and adult coloproctology. Pathobiology 72:1–102PubMedGoogle Scholar
  112. 112.
    Meier-Ruge WA, Bruder E, Kapur RP (2006) Intestinal neuronal dysplasia type B: one giant ganglion is not good enough. Pediatr Dev Pathol 9:444–452. doi: 10.2350/06-06-0109.1 PubMedGoogle Scholar
  113. 113.
    Meier-Ruge W, Gambazzi F, Käufeler RE, Schmid P, Schmidt CP (1994) The neuropathological diagnosis of neuronal intestinal dysplasia (NID B). Eur J Pediatr Surg 4:267–273. doi: 10.1055/s-2008-1066116 PubMedGoogle Scholar
  114. 114.
    Milde P, Guccion JG, Kelly J, Locatelli E, Jones RV (2001) Adult polyglucosan body disease. Arch Pathol Lab Med 125:519–522PubMedGoogle Scholar
  115. 115.
    Miller SM, Narasimhan RA, Schmalz PF, Soffer EE, Walsh RM, Krishnamurthi V et al (2008) Distribution of interstitial cells of Cajal and nitrergic neurons in normal and diabetic human appendix. Neurogastroenterol Motil 20:349–357. doi: 10.1111/j.1365-2982.2007.01040.x PubMedGoogle Scholar
  116. 116.
    Mitros FA, Schuffler MD, Teja K, Anuras S (1982) Pathologic features of familial visceral myopathy. Hum Pathol 13:825–833. doi: 10.1016/S0046-8177(82)80079-8 PubMedGoogle Scholar
  117. 117.
    Moscoso GJ, Driver M, Guy RJ (1986) A form of necrobiosis and atrophy of smooth muscle in diabetic gastric autonomic neuropathy. Pathol Res Pract 181:188–194PubMedGoogle Scholar
  118. 118.
    National Institute for Health and Clinical Excellence (2007) Making group decisions and reaching consensus. The Guidelines Manual, Chap 9, April, p 58Google Scholar
  119. 119.
    Navarro J, Sonsino E, Boige N, Nabarra B, Ferkadji L, Mashako LMN et al (1990) Visceral neuropathies responsible for chronic intestinal pseudo-obstruction syndrome in pediatric practice: analysis of 26 cases. J Pediatr Gastroenterol Nutr 11:179–195. doi: 10.1097/00005176-199008000-00006 PubMedCrossRefGoogle Scholar
  120. 120.
    N-Fékété C, Ricour C, Martelli H, Lortat Jacob S, Pelleyin D (1986) Total colonic aganglionosis (with or without ileal involvement): A review of 27 cases. J Pediatr Surg 21:251–254. doi: 10.1016/S0022-3468(86)80847-8 PubMedGoogle Scholar
  121. 121.
    Ohlsson B, Fork F-T, Veress B, Tóth E (2004) Coexistent chronic idiopathic intestinal pseudo obstruction and inflammatory bowel disease. Gut 54:729–730. doi: 10.1136/gut.2004.058826 Google Scholar
  122. 122.
    Ohlsson B, Veress B, Janciauskiene S, Montgomery A, Haglund M, Wallmark A (2007) Chronic intestinal pseudo-obstruction due to buserelin-induced formation of anti-GnRH antibodies. Gastroenterology 132:45–51. doi: 10.1053/j.gastro.2006.10.036 PubMedGoogle Scholar
  123. 123.
    O’Kelly TJ, Davies JR, Tam PK, Brading AF, Mortensen NJ (1994) Abnormalities of nitric-oxide-producing neurons in Hirschsprung’s disease: morphology and implications. J Pediatr Surg 29:294–299. doi: 10.1016/0022-3468(94)90335-2 PubMedGoogle Scholar
  124. 124.
    Park HJ, Kamm MA, Abbasi M, Talbot IC (1995) Immunohistochemical study of the colonic muscle and innervation in idiopathic chronic constipation. Dis Colon Rectum 38:509–513. doi: 10.1007/BF02148851 PubMedGoogle Scholar
  125. 125.
    Pasha SF, Lunsford TN, Lennon VA (2006) Autoimmune gastrointestinal dysmotility treated successfully with pyridostigmine. Gastroenterology 131:1592–1596. doi: 10.1053/j.gastro.2006.06.018 PubMedGoogle Scholar
  126. 126.
    Phillips RJ, Powley TL (2007) Innervation of the gastrointestinal tract: patterns of aging. Auton Neurosci 136:1–19. doi: 10.1016/j.autneu.2007.04.005 PubMedGoogle Scholar
  127. 127.
    Porter AJ, Wattchow DA, Brookes SJH, Costa M (1997) The neurochemical coding and projections of circular muscle motor neurons in the human colon. Gastroenterology 113:1916–1923. doi: 10.1016/S0016-5085(97)70011-8 PubMedGoogle Scholar
  128. 128.
    Porter AJ, Wattchow DA, Hunter A, Costa M (1998) Abnormalities of nerve fibres in the circular muscle of patients with slow transit constipation. Int J Colorectal Dis 13:208–216. doi: 10.1007/s003840050163 PubMedGoogle Scholar
  129. 129.
    Preston DM, Butler P, Smith B, Lennard-Jones JE (1984) The neuropathology of slow-transit constipation (abstr). Gut 24:A997Google Scholar
  130. 130.
    Qualman SJ, Jaffe R, Bove KE, Monforte-Muñoz H (1999) Diagnosis of Hirschsprung’s disease using the rectal biopsy: multi-institutional survey. Pediatr Dev Pathol 2:588–596. doi: 10.1007/s100249900167 PubMedGoogle Scholar
  131. 131.
    Quinn FM, Surana R, Puri P (1994) The influence of trisomy 21 on outcome in children with Hirschsprung’s disease. J Pediatr Surg 29:781–783. doi: 10.1016/0022-3468(94)90369-7 PubMedGoogle Scholar
  132. 132.
    Rajan E, Gostout CJ, Lurken MS, Talley NJ, Locke GR, Szarka LA et al (2008) Endoscopic “no hole” full-thickness biopsy of the stomach to detect myenteric ganglia. Gastrointest Endosc 67:497–501. doi: 10.1016/j.gie.2007.06.024 PubMedGoogle Scholar
  133. 133.
    Rudolph CD, Hyman PE, Altschuler SM, Christensen J, Colletti RB, Cucchiara S (1997) Diagnosis and treatment of chronic intestinal pseudo-obstruction in children: report of consensus workshop. J Pediatr Gastroenterol Nutr 24:102–112. doi: 10.1097/00005176-199701000-00021 PubMedGoogle Scholar
  134. 134.
    Ruuska TH, Karikoski R, Smith VV, Milla PJ (2002) Acquired myopathic intestinal pseudo-obstruction may be due to autoimmune enteric leiomyositis. Gastroenterology 122:1133–1139PubMedGoogle Scholar
  135. 135.
    Schärli AF, Meier-Ruge W (1981) Localized and disseminated forms of neuronal intestinal dysplasia mimicking Hirschsprung’s disease. J Pediatr Surg 16:164–170. doi: 10.1016/S0022-3468(81)80344-2 PubMedGoogle Scholar
  136. 136.
    Schuffler MD, Bird TD, Sumi SM, Cook A (1978) A familial neuronal disease presenting as intestinal pseudoobstruction. Gastroenterology 75:889–898PubMedGoogle Scholar
  137. 137.
    Schuffler MD, Jonak Z (1982) Chronic idiopathic intestinal pseudo-obstruction caused by a degenerative disorder of the myenteric plexus: The use of Smith’s method to define the neuropathology. Gastroenterology 82:476–486PubMedGoogle Scholar
  138. 138.
    Schuffler MD, Lowe MC, Bill AH (1977) Studies of idiopathic intestinal pseudoobstruction I. Hereditary hollow visceral myopathy: clinical and pathological studies. Gastroenterology 73:327–338PubMedGoogle Scholar
  139. 139.
    Selgrad M, De Giorgio R, Fini L, Cogliandro RF, Williams S, Stanghellini V et al (2008) JC virus infects the enteric glia of patients with chronic idiopathic intestinal pseudo-obstruction. Gut 14:6717–6721Google Scholar
  140. 140.
    Shäppi MG, Smith VV, Milla PJ, Lindley K (2003) Eosinophilic myenteric ganglionitis is associated with functional intestinal obstruction. Gut 52:752–755. doi: 10.1136/gut.52.5.752 Google Scholar
  141. 141.
    Sisodia SS (1998) Nuclear inclusions in glutamine repeat disorders: Are they pernicious, coincidental, or beneficial? Cell 95:1–4. doi: 10.1016/S0092-8674(00)81743-2 PubMedGoogle Scholar
  142. 142.
    Smith BF (1972) The neuropathology of the alimentary tract. Edward Arnold, LondonGoogle Scholar
  143. 143.
    Smith VV (1993) Neuron density in normal intestine in childhood as a basis for the assessment of hypo and hyperganglionosis. In: Morphological assessment of enteric neuromuscular disease causing intestinal pseudo-obstruction, PhD Thesis, University of London, pp 77-98Google Scholar
  144. 144.
    Smith VV (1993) Intestinal neuronal density in childhood: a baseline for the objective assessment of hypo- and hyperganglionosis. Pediatr Pathol 13:225–237. doi: 10.3109/15513819309048209 PubMedGoogle Scholar
  145. 145.
    Smith VV, Eng C, Milla PJ (1999) Intestinal ganglioneuromatosis and multiple endocrine neoplasia type 2B: implications for treatment. Gut 45:143–146PubMedCrossRefGoogle Scholar
  146. 146.
    Smith VV, Gregson N, Foggensteiner L, Neale G, Milla PJ (1997) Acquired intestinal aganglionosis and circulating autoantibodies without neoplasia or other neural involvement. Gastroenterology 112:1366–1371. doi: 10.1016/S0016-5085(97)70151-3 PubMedGoogle Scholar
  147. 147.
    Smith VV, Lake BD, Kamm MA, Nicholls JR (1992) Intestinal pseudo-obstruction with deficient smooth muscle alpha actin. Histopathology 21:535–542. doi: 10.1111/j.1365-2559.1992.tb00441.x PubMedGoogle Scholar
  148. 148.
    Smith VV, Milla PJ (1997) Histological phenotypes of enteric smooth muscle disease causing functional intestinal obstruction in childhood. Histopathology 31:112–122. doi: 10.1046/j.1365-2559.1997.2250839.x PubMedGoogle Scholar
  149. 149.
    Smith VV, Schäppi MG, Bisset WM, Kiparissi F, Jaffe A, Milla PJ, et al. (2009) Lymphocytic leiomyositis and myenteric ganglionitis are intrinsic features of cystic fibrosis: studies in distal ileal obstruction syndrome and meconium ileus. J Pediatr Gastroenterol Nutr (in press)Google Scholar
  150. 150.
    Spiller R, Jenkins D, Thornley J, Hebden J, Wright T, Skinner M et al (2000) Increased rectal mucosal enteroendocrine cells, T lymphocytes, and increased gut permeability following acute Campylobacter enteritis and in post-dysenteric “irritable bowel syndrome”. Gut 47:804–811. doi: 10.1136/gut.47.6.804 PubMedGoogle Scholar
  151. 151.
    Streutker C, Huizinga JD, Campbell F, Ho J, Riddell RH (2003) Loss of CD117 (c-kit)- and CD34-positive ICC and associated CD34-positive fibroblasts defines a subpopulation of chronic intestinal pseudo-obstruction. Am J Surg Pathol 27:228–235. doi: 10.1097/00000478-200302000-00012 PubMedGoogle Scholar
  152. 152.
    Streutker CJ, Huizinga JD, Driman DK, Riddell RH (2007) Interstitial cells of Cajal in health and disease. Part I: normal ICC structure and function with associated motility disorders. Histopathology 50:176–189. doi: 10.1111/j.1365-2559.2006.02493.x PubMedGoogle Scholar
  153. 153.
    Swenson O, Fisher JH (1959) Hirschsprung’s disease in the newborn. Arch Surg 79:987–993PubMedGoogle Scholar
  154. 154.
    Tafazzoli K, Soost K, Wessel L, Wedel T (2005) Topographic pecularities of the submucous plexus in the human anorectum–consequences for histopathologic evaluation of rectal biopsies. Eur J Pediatr Surg 15:159–163. doi: 10.1055/s-2005-837601 PubMedGoogle Scholar
  155. 155.
    Tanner MS, Smith B, Lloyd JK (1976) Functional intestinal obstruction due to deficiency of argyrophil neurones in the myenteric plexus. Familial syndrome presenting with short small bowel, malrotation, and pyloric hypertrophy. Arch Dis Child 51:837–841. doi: 10.1136/adc.51.11.837 PubMedGoogle Scholar
  156. 156.
    Törnblom H, Lindberg G, Nyberg B, Veress B (2002) Full-thickness biopsy of the jejunum reveals inflammation and enteric neuropathy in irritable bowel syndrome. Gastroenterology 123:1972–1979. doi: 10.1053/gast.2002.37059 PubMedGoogle Scholar
  157. 157.
    Veress B, Franzen L, Bodin L, Borch K (2004) Duodenal intraepithelial lymphocyte-count revisited. Scand J Gastroenterol 39:138–144. doi: 10.1080/00365520310007675 PubMedGoogle Scholar
  158. 158.
    Wattchow DA, Porter AJ, Brookes SJH, Costa M (1997) The polarity of neurochemically defined myenteric neurons in the human colon. Gastroenterology 113:497–506. doi: 10.1053/gast.1997.v113.pm9247469 PubMedGoogle Scholar
  159. 159.
    Wedel T, Roblick U, Gleiss J, Schiedeck T, Bruch HP, Kühnel W et al (1999) Organization of the enteric nervous system in the human colon demonstrated by wholemount immunohistochemistry with special reference to the submucous plexus. Ann Anat 181:327–337. doi: 10.1016/S0940-9602(99)80122-8 PubMedGoogle Scholar
  160. 160.
    Wedel T, Roblick UJ, Ott V, Eggers R, Schiedeck THK, Krammer HJ (2002) Oligoneuronal hypoganglionosis in patients with idiopathic slow transit constipation. Dis Colon Rectum 45:54–62. doi: 10.1007/s10350-004-6114-3 PubMedGoogle Scholar
  161. 161.
    Wedel T, Spiegler J, Söllner S, Roblick UJ, Schiedeck THK, Bruch HP et al (2002) Enteric nerves and interstitial cells of Cajal are altered in patients with slow-transit constipation and megacolon. Gastroenterology 123:1459–1467. doi: 10.1053/gast.2002.36600 PubMedGoogle Scholar
  162. 162.
    Wedel T, van Eys G, Glénisson W, Waltregny D, Vanderwinden JM (2006) Novel smooth muscle markers reveal abnormalities of the intestinal musculature in severe colorectal motility disorders. Neurogastroenterol Motil 18:526–538. doi: 10.1111/j.1365-2982.2006.00781.x PubMedGoogle Scholar
  163. 163.
    White FV, Langer JC (2000) Circumferential distribution of ganglion cells in the transitional zone of children with Hirschsprung disease. Pediatr Dev Pathol 3:216–222. doi: 10.1007/s100249910028 PubMedGoogle Scholar
  164. 164.
    Whitehouse FR, Kernohan JW (1948) Myenteric plexus in congenital megacolon; study of 11 cases. Arch Intern Med Chic 82:75–111PubMedGoogle Scholar
  165. 165.
    Wilder-Smith CH, Talbot IC, Merki HS, Meier-Ruge WA (2002) Morphometric quantification of normal submucous plexus in the distal rectum of adult healthy volunteers. Eur J Gastroenterol Hepatol 14:1339–1342. doi: 10.1097/00042737-200212000-00009 PubMedGoogle Scholar
  166. 166.
    Wingate D, Hongo M, Kellow J, Lindberg G, Smout A (2002) Disorders of gastrointestinal motility: towards a new classification. J Gastroenterol Hepatol 17(Suppl):S1–S14. doi: 10.1046/j.1440-1746.17.s1.7.x PubMedGoogle Scholar
  167. 167.
    Woods KL, Anand BS, Cole RA, Osato MS, Genta RM, Malaty H et al (1999) Influence of endoscopic biopsy forceps characteristics on tissue specimens: results of a prospective randomized study. Gastrointest Endosc 49:177–183. doi: 10.1016/S0016-5107(99)70483-9 PubMedGoogle Scholar
  168. 168.
    Yoo SY, Jung SH, Eom M, Kim IH, Han A (2002) Delayed maturation of interstitial cells of Cajal in meconium obstruction. J Pediatr Surg 37:1758–1761. doi: 10.1053/jpsu.2002.36715 PubMedGoogle Scholar
  169. 169.
    Yoshida MM, Krishnamurthy S, Wattchow DA, Furness JB, Schuffler MD (1988) Megacolon in myotonic dystrophy caused by a degenerative neuropathy of the myenteric plexus. Gastroenterology 95:820–827PubMedGoogle Scholar
  170. 170.
    Yu CS, Kim HC, Hong HK, Chung DH, Kim HJ, Kang GH et al (2002) Evaluation of myenteric ganglion cells and interstitial cells of Cajal in patients with chronic idiopathic constipation. Int J Colorectal Dis 17:253–258. doi: 10.1007/s00384-001-0380-5 PubMedGoogle Scholar
  171. 171.
    Yunis EJ, Dibbins AW, Sherman FE (1976) Rectal suction biopsy in the diagnosis of Hirschsprung’s disease. Arch Pathol Lab Med 100:329–333PubMedGoogle Scholar
  172. 172.
    Zarate N, Wang XY, Tougas G, Anvari M, Birch D, Mearin F et al (2006) Intramuscular interstitial cells of Cajal associated with mast cells survive nitrergic nerves in achalasia. Neurogastroenterol Motil 18:556–568. doi: 10.1111/j.1365-2982.2006.00788.x PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Charles H. Knowles
    • 1
    • 16
    Email author
  • Roberto De Giorgio
    • 2
  • Raj P. Kapur
    • 3
  • Elisabeth Bruder
    • 4
    • 5
  • Gianrico Farrugia
    • 6
  • Karel Geboes
    • 7
  • Michael D. Gershon
    • 8
  • John Hutson
    • 9
  • Greger Lindberg
    • 10
  • Joanne E. Martin
    • 1
  • William A. Meier-Ruge
    • 4
  • Peter J. Milla
    • 11
  • Virpi V. Smith
    • 12
  • Jean Marie Vandervinden
    • 13
  • Béla Veress
    • 14
  • Thilo Wedel
    • 15
  1. 1.Neurogastroenterology Group, Centres for Academic Surgery and Pathology, Institute of Cellular and Molecular ScienceBarts and the London School of Medicine and Dentistry, Queen Mary University LondonLondonUK
  2. 2.Department of Clinical MedicineAlma Mater Studiorum University of BolognaBolognaItaly
  3. 3.Department of PathologySeattle Children’s Hospital, University of WashingtonSeattleUSA
  4. 4.Institute of Pathology, University Hospital BaselBaselSwitzerland
  5. 5.Department of PathologyUniversity Hospital ZurichZurichSwitzerland
  6. 6.Enteric NeuroScience Program, Division of Gastroenterology and HepatologyMayo Clinic College of MedicineRochesterUSA
  7. 7.Department of PathologyUniversity Hospital KULLouvainBelgium
  8. 8.Anatomy and Cell Biology FacultyColumbia University Medical CenterNew YorkUSA
  9. 9.Urology DepartmentsRoyal Children’s Hospital, University of Melbourne and General SurgeryVICAustralia
  10. 10.Department of MedicineKarolinska Institutet, Karolinska University Hospital HuddingeStockholmSweden
  11. 11.UCL Institute of Child HealthLondonUK
  12. 12.Department of HistopathologyCamelia Botnar Hospital, Great Ormond Street Hospital NHS TrustLondonUK
  13. 13.Laboratory of Neurophysiology, Faculty of MedicineUniversité Libre de BruxellesBrusselsBelgium
  14. 14.Department of Clinical Pathology and CytologyUniversity Hospital MAS, Lunds UniversityMalmöSweden
  15. 15.Anatomisches Institut, Christian-Albrechts-Universität zu KielKielGermany
  16. 16.Centre for Academic Surgery Royal London HospitalLondonUK

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