A decreased number of c- kit -expressing cells in a patient with afferent loop syndrome

Abstract

Following gastrectomy, stasis in the afferent jejunal loop accompanied by an overgrowth of bacteria leads to a number of clinical symptoms, including the so-called afferent loop syndrome. The disturbances in intestinal motility may be related to stagnation of the intestinal contents in the afferent loop. The pacemaker cells for the basic contractile activity of the intestine are thought to be the interstitial cells of Cajal (ICCs). We and others have reported that ICCs express the c- kit receptor, and that a decreased number of c- kit-expressing ICCs is generally thought to result in disturbed intestinal motility. We report here a patient with postgastrectomy afferent loop syndrome with a decreased number of c- kit-expressing cells in the external muscle layer of the dilated intestine, suggesting damage to the ICCs.

Restoration of gut motility in Kit-deficient mice by bone marrow transplantation

“…Deficiency of ICC has been demonstrated in various gastrointestinal motility disorders in humans and animals [1][2][3][4][5][6][7][8][9][10][11][12][13][23][24][25], including the above-mentioned motor disorders. ICCs direct the electrical rhythmicity and peristalsis of the gut [26,39].…”

“…ICC may also play similar roles in other tubular, smooth muscle-lined organs, such as the urethra and lymph vessels, in a wide range of species [2]. Absence of, or a decrease in, ICC has been reported in patients with chronic pseudo-obstruction [3], achalasia of cardia [4], pyloric stenosis [4], colonic inertia [5], afferent loop syndrome [6], internal anal sphincter achalasia [7], Hirschsprung's disease [7], and gut dysmotility associated with diabetes mellitus [8][9][10]. In addition, partial bowel obstruction [11], surgical resection of the gut [12], and jejunal inflammation [13] disrupt ICC networks and cause abnormal motility.…”

Recurrent Cholangitis by Biliary Stasis Due to Non-Obstructive Afferent Loop Syndrome After Pylorus-Preserving Pancreatoduodenectomy: Report of a Case

“…Nonobstructive afferent loop syndrome leads to retrograde cholangitis, liver abscess, and the formation of enterolithiasis or intrahepatic lithiasis, and occurs in around 37% of all of the afferent loop syndrome cases. 12–14 It is thought that sump syndrome after hepaticojejunostomy presents the same pathology as nonobstructive afferent loop syndrome. 15–17 …”

Alterations of interstitial cells of Cajal and gastrointestinal motility disorders

“…However, as Kiyohara et al 20 have noted, there seem to be some issues that should be carefully considered. First, does the lack of detectable KIT immunoreactivity really indicate the loss of ICCs?…”

“…In this issue of the Journal of Gastroenterology, Kiyohara et al 20 report a decrease in ICCs in a patient with afferent loop syndrome that was observed 39 years after a subtotal gastrectomy with a Billroth II gastrojejunostomy and 26 years after an additional partial Interstitial cells of Cajal (ICCs) in the gastrointestinal (GI) tract were first described by Cajal 1 in 1893 as primitive neurons in autonomically innervated organs. Since then, with the use of light and then electron microscopy, considerable debate about the distribution, origin, and function of ICCs has continued over the years.…”