Paraneoplastic chronic intestinal pseudoobstruction as a rare complication of bronchial carcinoid.

Gerl, Arthur; Storck, M.; Schalhorn, Andreas; Müller‐Höcker, Josef; Jauch, K.-W.; Schildberg, F. W.; Wilmanns, W.

doi:10.1136/gut.33.7.1000

Cited by 49 publications

(22 citation statements)

References 21 publications

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“…A reduction in the volume of the ICC or damage to their process has been reported in almost every clinical motility disorder that has been investigated, including Hirschsprung's disease (89,90,173), chronic constipation (198), slow-transit constipation (7,67,189), megacolon (189), gastroparesis (199), diabetic mellitus (108), inflammatory bowel disease, animal models of inflammation (102,122,127), pyloric stenosis (92,172,195), achalasia (56,61,63), and chronic idiopathic intestinal obstruction (81,156). However, there are little or no data to correlate the abnormalities of specific subtypes of ICC with specific features of motility dysfunction or clinical symptoms.…”

Section: Icc In Gastrointestinal Motility Disordersmentioning

confidence: 99%

Are interstitial cells of Cajal plurifunction cells in the gut?

Sarna¹

2008

American Journal of Physiology-Gastrointestinal and Liver Physi

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The proposed functions of the interstitial cells of Cajal (ICC) are to 1) pace the slow waves and regulate their propagation, 2) mediate enteric neuronal signals to smooth muscle cells, and 3) act as mechanosensors. In addition, impairments of ICC have been implicated in diverse motility disorders. This review critically examines the available evidence for these roles and offers alternate explanations. This review suggests the following: 1) The ICC may not pace the slow waves or help in their propagation. Instead, they may help in maintaining the gradient of resting membrane potential (RMP) through the thickness of the circular muscle layer, which stabilizes the slow waves and enhances their propagation. The impairment of ICC destabilizes the slow waves, resulting in attenuation of their amplitude and impaired propagation.2) The one-way communication between the enteric neuronal varicosities and the smooth muscle cells occurs by volume transmission, rather than by wired transmission via the ICC. 3) There are fundamental limitations for the ICC to act as mechanosensors.4) The ICC impair in numerous motility disorders. However, a cause-and-effect relationship between ICC impairment and motility dysfunction is not established. The ICC impair readily and transform to other cell types in response to alterations in their microenvironment, which have limited effects on motility function. Concurrent investigations of the alterations in slow-wave characteristics, excitationcontraction and excitation-inhibition couplings in smooth muscle cells, neurotransmitter synthesis and release in enteric neurons, and the impairment of the ICC are required to understand the etiologies of clinical motility disorders. smooth muscle; slow waves; enteric neurons; excitation-contraction coupling; peristaltic reflex; motility disorders; volume transmission; synaptic transmission, ICC THE INTERSTITIAL CELLS WERE characterized originally by Raymond V. Cajal (20,21). These cells got his attention and that of others because they are intercalated between the autonomic nerves and the effector cells. On the basis of the understanding of the interneuronal communication in the central nervous system (CNS) at that time, Cajal proposed that the intercalating cells [later called the interstitial cells of Cajal (ICC)] mediate the transmission of signals from the autonomic neurons to the smooth muscle cells. A few years later, Keith (84) observed a collar of similar cells in the myenteric plexus of the rat ileocecal junction. He was looking for a pacemaker of the gut smooth muscle electrical activity because a few years earlier he had identified such a pacemaker in the sinoatrial node of the heart. He hypothesized that those interstitial cells were the pacemaker cells in the gut. In the late 1960s and early 1970s, several investigators described a plexus of the ICC within the myenteric and submucosal plexi of the small and large intestines. They also identified close connections between the enteric axonal varicosities and ICC processes on one side and g...

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Section: Icc In Gastrointestinal Motility Disordersmentioning

confidence: 99%

Are interstitial cells of Cajal plurifunction cells in the gut?

Sarna¹

2008

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…The anti-hu antibodies are useful to indicate this condition, as shown in bronchial small cell carcinoma [171]. In pheochromocytoma [172] and carcinoid [173] neuromediators affecting small bowel motility are produced by the tumor cells.…”

Section: Paraneoplastic Syndromesmentioning

confidence: 99%

The Pathogenesis of Gastrointestinal Bacterial Overgrowth

Husebye

2005

Chemotherapy

138

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The normal indigenous intestinal microflora consists of about 10¹⁵ bacteria that under physiological conditions reside mainly in the lower gastrointestinal tract. Bacterial overgrowth implies abnormal bacterial colonization of the upper gut, resulting from failure of specific defense mechanisms restricting colonization under physiological conditions. At present two types of bacterial overgrowth with defined pathogenesis can be distinguished: (1) gastric overgrowth with upper respiratory tract microflora resulting from selective failure of the gastric acid barrier, and (2) gastrointestinal overgrowth with Gram-negative bacilli (enteric bacteria) resulting from failure of intestinal clearance. Helicobacter pylori-induced gastritis of the oxyntic mucosa is the main cause of acquired failure of the gastric acid barrier, which is common among the healthy elderly. Intestinal clearance may fail as the result of impaired intestinal peristalsis or anatomical abnormalities that alter luminal flow. Impaired peristalsis is associated with conditions interfering with intestinal neuromuscular function including myopathic, neuropathic, autoimmune, infectious, inflammatory, metabolic, endocrine, and neoplastic diseases. Anatomical abnormalities are mainly the result of gastrointestinal surgery, intestinal diverticula or fistula. Combined failure of intestinal clearance and the gastric acid barrier results in more severe colonization with Gram-negative bacilli. Gram-negative bacilli are uncommon in the upper gut of otherwise healthy individuals with gastric hypochlorhydria, being acquired (H. pylori) or drug-induced. Significant bacterial overgrowth with Gram-negative bacilli is a rational in the search for an explanation to optimize clinical management. The clinical significance of colonization with upper respiratory tract microflora remains unclear. Translocation of live bacteria, their metabolic products, or antigens from a small bowel colonized by Gram-negative bacilli play a role in the pathogenesis of spontaneous bacterial peritonitis in hepatic disease and in certain types of sepsis, indicating that further studies can point to new patient populations with potential benefit from medical treatment.

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“…Though most often seen in the setting of either small cell lung cancer or thymoma, there have been several case reports of patients with pseudo-obstruction with other primary cancers. Chronic intestinal pseudoobstruction along with achalasia, gastroparesis and constipation was reported in a patient with metastasizing bronchial carcinoid [45]. Intestinal pseudoobstruction associated with lymphoplasmacytic infiltration of the myenteric plexus and presence of ANNA-1 antibodies was found in a patient about one and a half years after removal of paravertebral ganglioneuroblastoma [46].…”

Section: Paraneoplastic Chronic Intestinal Pseudoobstructionmentioning

confidence: 97%

Enteric Autoantibodies and Gut Motility Disorders

Kashyap

Farrugia

2008

Gastroenterology Clinics of North America

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There is increasing evidence that a subset of gastrointestinal motility disorders is associated with the presence of circulating antibodies. These antibodies are directed against various molecular targets, the best known being anti-neuronal nuclear antibody (ANNA-1, aka anti-Hu) associated with paraneoplastic motility disorders. There is also evidence that the presence of distinct auto-antibody profiles is associated with non-paraneoplastic motility disorders. This review will focus on the types of antibodies associated with gastrointestinal motility disorders and the significance of these antibodies. The review will also suggest algorithms for the work up and treatment of patients with circulating antibodies associated with gastrointestinal motility disorders

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Paraneoplastic chronic intestinal pseudoobstruction as a rare complication of bronchial carcinoid.

Cited by 49 publications

References 21 publications

Are interstitial cells of Cajal plurifunction cells in the gut?

Are interstitial cells of Cajal plurifunction cells in the gut?

The Pathogenesis of Gastrointestinal Bacterial Overgrowth

Enteric Autoantibodies and Gut Motility Disorders

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