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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

Abstract

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.

Keywords

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

Abbreviations

AChE

Acetylcholinesterase

CIPO

Chronic intestinal pseudo-obstruction

GINMD

Gastrointestinal neuromuscular disease

GINMP

Gastrointestinal neuromuscular pathology

H&E

Haematoxylin and eosin

HSCR

Hirschsprung disease

IBS

Irritable bowel syndrome

ICC

Interstitial cells of Cajal

IELs

Intraepithelial lymphocytes

IHC

Immunohistochemistry

IND

Intestinal neuronal dysplasia

IWG

International working group

NOTES

Natural orifice transluminal endoscopic surgery

NSE

Neuron specific enolase

PAS

Periodic acid-Schiff

PGP 9.5

Protein gene product 9.5

SRB

Suction rectal biopsy

TEM

Transmission electron microscopy

Notes

Acknowledgments

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)

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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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