Abstract
The interstitial cells of Cajal (ICCs) are fundamental in the generation of gastric slow waves. The role of these cells in gastroparesis has not been established. We studied 14 gastroparetic patients (9 diabetic, 4 idiopathic, and 1 postsurgical) for whom standard medical therapy had failed and who had been treated with a gastric electrical stimulator for at least 3 months. All patients had a full-thickness antral gastric wall biopsy at the time of surgery. The biopsy samples were stained with c -kit and scored for the presence of ICCs. Baseline electrogastrogram recordings were obtained for 30 minutes in the fasting state and for 2 hours after a test meal. The patients assessed their total symptom score at baseline and at 3 months. Five patients had almost no ICCs and were compared with nine patients with 20% to normal cell numbers. Both groups did respond symptomatically to gastric electrical stimulation. However, patients with depleted ICCs had significantly more tachygastria and had significantly greater total symptom scores at baseline and after 3 months of gastric electrical stimulation. ICCs are absent in some patients (up to a third) with diabetic or idiopathic gastroparesis, and the absence of these cells is associated with abnormalities of gastric slow waves, worse symptoms, and less improvement with gastric electrical stimulation.
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Hornbuckle K, Barnett JL. The diagnosis and work-up of the patient with gastroparesis. J Clin Gastroenterol 2000;30:117–124.
Tougas G, Eaker EY, Abell TL, et al. Assessment of gastric emptying using a low fat meal: Establishment of international control values. Am J Gastroenterol 2000;95:1456–1462.
Sturm A, Holtmann G, Goebell H, Gerken G. Prokinetics in patients with gastgroparesis: A systematic analysis. Digestion 1999;60:422–427.
Reardon TM, Schnell GA, Smith OJ, Schubert TT. Surgical therapy of diabetic gastroparesis. J Clin Gastroenterol 1989; 11:204–207.
Ejskjaer NT, Bradley JL, Buston-Thomas MS, et al. Novel surgical treatment and gastric pathology in diabetic gastroparesis. Diabetic Med 1999;16:488–495.
McCallum RW, Chen JD, Lin Z, et al. Gastric pacing improves emptying and symptoms in patients with gastroparesis. Gastroenterology 1998;114:456–461.
Forster J, Sarosiek I, Delcore R, Lin Z, Raju GS, McCallum. Gastric pacing—A novel surgical treatment for gastroparesis. Am J Surg 2001;182:676–681.
Ordog T, Ward SM, Sanders KM. Interstitial cells of Cajal generate slow waves in the murine stomach. J Physiol 1999; 518:257–269.
Sanders KM, Ordog T, Koh SD, Torihashi S, Ward SM. Development and plasticity of interstitial cells of Cajal. Neurogastroenterol Motil 1999;11:311–338.
Huizinga JD, Thuneberg L, Kluppel M, Malysz J, Mikkelsen HB, Bernstein A. W/kit gene required for interstitial cells of Cajal and for intestinal pacemaker activity. Nature 1995;373:347–349.
Min K-W, Seo IS. Interstitial Cells of Cajal in the human small intestine: Immunochemical and ultrastructural study. Ultrastruct Pathol 2003;27:67–78.
Ordog 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;49:1731–1739.
Lin Z, Eaker EY, Sarosiek I, McCallum RW. Gastric myoelectrical activity and gastric emptying in patients with functional dyspepsia. Am J Gastroenterol 1999;94:2384–2389.
Chen JDZ, McCallum RW. Electrogastrographic parameters and their clinical significance. In Chen JDZ, McCallum RW, eds. Electrogastrography: Principles and Applications. New York: Raven Press, 1994, pp 45–73.
Forster J, Sarosiek I, Lin Z, et al. Further experience with gastric stimulation to treat drug refractory gastroparesis: Report of a large single center series. Am J Surg 2003;186:690–695.
Abell T, McCallum R, Hocking M, et al. Gastric electrical stimulation for medically refractory gastroparesis. Gastroenterology 2003;125:421–428.
Lin Z, Forster J, Sarosiek, McCallum RW. Effect of highfrequency electrical stimulation on gastric myoelectric activity in gastroparetic patients. Neurogastroenterol Motil 2004;16:205–212.
Lin Z, Forster J, Sarosiek I, Damjanov I, McCallum RW. Baseline status of interstitial cells of Cajal predicts long-term symptom improvement in gastroparetic patients treated with gastric electrical stimulation. Gastroenterology 2004;126(Suppl 2):A-73.
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Forster, J., Damjanov, I., Lin, Z. et al. Absence of the interstitial cells of cajal in patients with gastroparesis and correlation with clinical findings. J Gastrointest Surg 9, 102–108 (2005). https://doi.org/10.1016/j.gassur.2004.10.001
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DOI: https://doi.org/10.1016/j.gassur.2004.10.001