Advances in our understanding of the pathology of chronic intestinal pseudo-obstruction

de Giorgio, R.; Sarnelli, G.; Corinaldesi, R.; Stanghellini, V.
December 2004
Gut;Dec2004, Vol. 53 Issue 12, p1549
Academic Journal
The histopathology of chronic intestinal pseudo-obstruction has been frequently reported as a frustrating experience by gastrointestinal pathologists. Renewed interest in gut neuromuscular pathology has been fuelled by the availability of full thickness biopsies obtained with minimally invasive surgical techniques, improvement in tissue preservation, and refinement of a number of morphofunctional techniques. Pathological abnormalities underlying chronic idiopathic intestinal pseudo-obstruction can be classified into three major entities: neuropathies, "mesenchymopathies" (that is, changes in interstitial cells of Cajal network), and myopathies. Inflammatory/immune mediated neuropathies are characterised by either a predominant T cell (CD4 and CD8 lymphocytes) or eosinophilic infiltrate within the myenteric plexus. Other forms of neuropathies are characterised by loss of neurones together with evidence of neuro-degenerative aspects in the absence of an identifiable inflammatory response. Abnormalities of interstitial cells of Cajal and smooth muscle cells may also contribute to gut dysmotility. Combined clinical and histopathological studies will open new perspectives in the understanding and management of chronic intestinal pseudo-obstruction.


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