Clinical-histological associations in gastroparesis: results from the Gastroparesis Clinical Research Consortium.

Abstract

BACKGROUND:

Cellular changes associated with diabetic (DG) and idiopathic gastroparesis (IG) have recently been described from patients enrolled in the Gastroparesis Clinical Research Consortium. The association of these cellular changes with gastroparesis symptoms and gastric emptying is unknown. The aim of this study was to relate cellular changes to symptoms and gastric emptying in patients with gastroparesis.

METHODS:

Earlier, using full thickness gastric body biopsies from 20 DG, 20 IG, and 20 matched controls, we found decreased interstitial cells of Cajal (ICC) and enteric nerves and an increase in immune cells in both DG and IG. Here, demographic, symptoms [gastroparesis cardinal symptom index score (GCSI)], and gastric emptying were related to cellular alterations using Pearson's correlation coefficients.

KEY RESULTS:

Interstitial cells of Cajal counts inversely correlated with 4 h gastric retention in DG but not in IG (r = -0.6, P = 0.008, DG, r = 0.2, P = 0.4, IG). There was also a significant correlation between loss of ICC and enteric nerves in DG but not in IG (r = 0.5, P = 0.03 for DG, r = 0.3, P = 0.16, IG). Idiopathic gastroparesis with a myenteric immune infiltrate scored higher on the average GCSI (3.6 ± 0.7 vs 2.7 ± 0.9, P = 0.05) and nausea score (3.8 ± 0.9 vs 2.6 ± 1.0, P = 0.02) as compared to those without an infiltrate.

CONCLUSIONS & INFERENCES:

In DG, loss of ICC is associated with delayed gastric emptying. Interstitial cells of Cajal or enteric nerve loss did not correlate with symptom severity. Overall clinical severity and nausea in IG is associated with a myenteric immune infiltrate. Thus, full thickness gastric biopsies can help define specific cellular abnormalities in gastroparesis, some of which are associated with physiological and clinical characteristics of gastroparesis.

• Authors: M Grover, C E Bernard, P J Pasricha, M S Lurken, M S Faussone-Pellegrini, T C Smyrk, H P Parkman, T L Abell, W J Snape, W L Hasler, R W McCallum, L Nguyen, K L Koch, J Calles, L Lee, J Tonascia, A Ünalp-Arida, F A Hamilton, G Farrugia, NIDDK Gastroparesis Clinical Research Consortium (GpCRC)
• Journal: Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society (Neurogastroenterol Motil) Vol. 24 Issue 6 Pg. 531-9, e249 (Jun 2012) ISSN: 1365-2982 [Electronic] England
• PMID: 22339929 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: © 2012 Blackwell Publishing Ltd.

Topics

• Adult
• Aged
• Enteric Nervous System (pathology, physiopathology)
• Female
• Gastric Emptying (physiology)
• Gastroparesis (pathology, physiopathology)
• Humans
• Interstitial Cells of Cajal (pathology, physiology)
• Male
• Middle Aged
• Severity of Illness Index
• Stomach (pathology, physiopathology)
• Surveys and Questionnaires