NEUROGASTROENTEROLOGY

Severe idiopathic gastroparesis due to neuronal and interstitial cells of Cajal degeneration: pathological findings and management

N Zárate¹, F Mearin¹, X-Y Wang², B Hewlett², J D Huizinga², J-R Malagelada¹

¹ Digestive System Research Unit, Hospital General Vall d’Hebron, Barcelona, Spain
² Intestinal Disease Research Program, McMaster University, Hamilton, Canada

Correspondence to:
Correspondence to:
Dr F Mearin, Institute of Functional and Motor Digestive Disorders, Centro Médico Teknon, Vilana 12, 08022 Barcelona, Spain;
fmearinm{at}meditex.es

Delayed gastric emptying can be due to muscular, neural, or humoral abnormalities. In the absence of an identified cause, gastroparesis is labelled as idiopathic. We present the case of a patient with severe idiopathic gastroparesis. Pharmacological approaches failed, as well as reduction in gastric emptying resistance with pyloric injection of botulinum toxin and pyloroplasty. Therefore, subtotal gastrectomy was performed. Histological and immunohistochemical study of the resected specimen showed hypoganglionosis, neuronal dysplasia, and a marked reduction in both myenteric and intramuscular interstitial cells of Cajal. To our knowledge, this is the first time these rare histological findings have been described in a patient with idiopathic gastroparesis.

Keywords: gastroparesis; interstitial cells of Cajal; barostat

Abbreviations: ICC, interstitial cells of Cajal; IG, idiopathic gastroparesis; BT, botulinum toxin; PGP, protein gene product

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