Quantitation of cellular components of the enteric nervous system in the normal human gastrointestinal tract - report on behalf of the Gastro 2009 International Working Group

Knowles, Charles H.; Veress, B; Kapur, Raj P.; Wedel, Thilo; Farrugia, Gianrico; Vanderwinden, Jean Marie; Geboes, Karel; Smith, Virpi V.; Martin, Joanne E.; Lindberg, Gunnar; Milla, Peter J.; Giorgio, Roberto De

doi:10.1111/j.1365-2982.2010.01657.x

Cited by 75 publications

(89 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition, patients with symptoms of severe dysmotility who underwent intestinal resection within the same time-frame were also identified. These patients were not considered for laparoscopic biopsy since full-thickness intestinal wall tissue was already available for analysis and thereby histopathological classification (14)(15)(16). Identified patients represent the majority of cases of suspected CIPO/ED in the most southern parts of Sweden.…”

Section: Subjectsmentioning

confidence: 99%

Depletion of enteric gonadotropin-releasing hormone is found in a few patients suffering from severe gastrointestinal dysmotility

Hammar

Ohlsson

Veress

et al. 2012

Scandinavian Journal of Gastroenterology

View full text Add to dashboard Cite

Depletion of enteric gonadotropin-releasing hormone is found in a few patients suffering from severe gastrointestinal dysmotility.Hammar, Oskar; Ohlsson, Bodil; Veress, Bela; Alm, Ragnar; Nordin Fredrikson, Gunilla; Montgomery, Agneta . (2012). Depletion of enteric gonadotropin-releasing hormone is found in a few patients suffering from severe gastrointestinal dysmotility. Scandinavian Journal of Gastroenterology, 47(10), 1165Gastroenterology, 47(10), -1173Gastroenterology, 47(10), . https://doi.org/10.3109/00365521.2012 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. GnRH and dysmotility AbstractObjective: Many patients, especially women, suffer from severe gastrointestinal pain and dysmotility for several years without being diagnosed. Depletion of gonadotropin-releasing hormone (GnRH) in the enteric nervous system (ENS) has been described in some patients.The aim of this study was to examine the expression of GnRH in ENS and antibodies against GnRH in serum, in a dysmotility patient cohort of southern Sweden. Materials and Methods:All consecutive patients (n=35) referred for laparoscopic fullthickness biopsy because of symptoms or signs of severe dysmotility between 1998 and 2009, or patients with a severe dysmotility disorder having had a bowel resection within the timeframe, were considered for inclusion. In 22 cases, representative biopsy material containing ganglia was available, and these patients were included. Medical records were scrutinized.The expression of GnRH was determined by immunohistochemistry in bowel biopsies from these patients and in patients with carcinoma or diverticulosis without ENS histopathology.Antibodies against GnRH in serum were determined by ELISA in patients and controls.Results: Fourteen patients were diagnosed with enteric dysmotility and 8 with chronic intestinal pseudo-obstruction due to varying etiology. Immunostained biopsies showed expression of GnRH in the ENS. A reduced expression of GnRH-containing neurons was found in 5 patients, as well as antibodies against GnRH in serum. Three of these patients had a history of in vitro fertilization (IVF) using GnRH analogs. Conclusions:A subgroup of patients with severe dysmotility had a reduced expression of GnRH-containing neurons in the ENS and expressed antibodies against GnRH in serum.

show abstract

Section: Subjectsmentioning

confidence: 99%

Depletion of enteric gonadotropin-releasing hormone is found in a few patients suffering from severe gastrointestinal dysmotility

Hammar

Ohlsson

Veress

et al. 2012

Scandinavian Journal of Gastroenterology

View full text Add to dashboard Cite

show abstract

“…In a previous article, this group had defined techniques for histopathological workup, interpretation, and reporting of intestinal neuromuscular disorders (3). A systematic review by the IWG revealed a lack of concordance in the quantitative assessment for elements of the enteric nervous system (ENS) (4).…”

mentioning

confidence: 99%

“…The 3 recent articles (2)(3)(4) by the IWG have tried to collate present knowledge in this field. Despite these comprehensive publications, the use of inaccurate terminology and vague diagnostic criteria remain common (9).…”

mentioning

confidence: 99%

A Practical Guide for the Diagnosis of Primary Enteric Nervous System Disorders

Schäppi

Staiano

Milla

et al. 2013

J. pediatr. gastroenterol. nutr.

View full text Add to dashboard Cite

Objective: Primary gastrointestinal neuropathies are a heterogeneous group of enteric nervous system (ENS) disorders that continue to cause difficulties in diagnosis and histological interpretation. Recently, an international working group published guidelines for histological techniques and reporting, along with a classification of gastrointestinal neuromuscular pathology. The aim of this article was to review and summarize the key issues for pediatric gastroenterologists on the diagnostic workup of congenital ENS disorders. In addition, we provide further commentary on the continuing controversies in the field. Results: Although the diagnostic criteria for Hirschsprung disease are well established, those for other forms of dysganglionosis remain ill-defined. Appropriate tissue sampling, handling, and expert interpretation are crucial to maximize diagnostic accuracy and reduce interobserver variability. The absence of validated age-related normal values for neuronal density, along with the lack of correlation between clinical and histological findings, result in significant diagnostic uncertainties while diagnosing quantitative aberrations such as hypoganglionosis or ultrashort Hirschsprung disease. Intestinal neuronal dysplasia remains a histological description of unclear significance. Conclusions:The evaluation of cellular quantitative or qualitative abnormalities of the ENS for clinical diagnosis remains complex. Such analysis should be carried out in laboratories that have the necessary expertise and access to their own validated reference values.

show abstract

“…Part of the apparent change in cellularity is due to agerelated changes in the size and shape of ganglion cells and the amount of intervening neuropil. Even if the number of ganglion cells per ganglion remains stable with age, individual ganglion cell somata enlarge, [21][22][23] which can influence the number of cytoplasmic profiles likely to be transected in a section of given thickness. This may be one reason for the age-related decline in submucosal ganglion size during infancy and early childhood.…”

Section: Inappropriate Extrapolation Of 1990 Frankfurt Consensus or 2mentioning

confidence: 99%

“…However, many studies have shown that counting ganglion cells, like many quantitative exercises in surgical pathology, is extremely vulnerable to interobserver bias. 20,21,29 In 1999, a group of pathologists, which included Meier-Ruge, Coerdt, and other experienced IND B diagnosticians, examined their own interobserver variability. 5 They observed that their ''j values were close to the zero value expected by chance for the diagnoses normal and IND B'' and concluded that ''with current knowledge, rectal biopsy for diagnostic purposes should only be performed in constipated children for diagnosis of Hirschsprung's disease.''…”

Section: Interobserver Variabilitymentioning

confidence: 99%

Intestinal Neuronal Dysplasia Type B: An Updated Review of a Problematic Diagnosis

Kapur

Reyes‐Múgica

2018

Archives of Pathology &Amp; Laboratory Medicine

View full text Add to dashboard Cite

Context.-Intestinal neuronal dysplasia type B (IND B) is a controversial histopathologic phenotype that has been associated with intestinal dysmotility, either as an isolated condition or in conjunction with established pathologic disorders (eg, Hirschsprung disease). Many factors contribute to the debate over the existence and/or clinical significance of IND B, including a large body of published data based on inconsistent diagnostic criteria and methods, which have fostered many unwarranted conclusions that lack sufficient scientific basis.Objective.-To critically analyze existing published data regarding IND B to provide supporting evidence-based diagnostic practice and to stimulate necessary and scientifically sound research.Data Sources.-This update focuses on published literature related to the pathology of IND B because without a reliable pathologic diagnosis, studies of epidemiology, pathogenesis, natural history, management, and outcome are all suspect. Problems with existing data are identified explicitly with suggestions as to how future investigations should be designed and evaluated to better understand this entity.Conclusions.-Inconsistencies in diagnostic criteria and methods used to define IND B justifiably encumber the universal acceptance of IND B as a neuropathologic etiology for intestinal dysmotility. IND B will remain a controversial diagnosis until rigorous, well-controlled scientific studies are conducted to establish reproducible and reliable diagnostic criteria that reliably translate from one laboratory to another.

show abstract

Quantitation of cellular components of the enteric nervous system in the normal human gastrointestinal tract - report on behalf of the Gastro 2009 International Working Group

Cited by 75 publications

References 54 publications

Depletion of enteric gonadotropin-releasing hormone is found in a few patients suffering from severe gastrointestinal dysmotility

Depletion of enteric gonadotropin-releasing hormone is found in a few patients suffering from severe gastrointestinal dysmotility

A Practical Guide for the Diagnosis of Primary Enteric Nervous System Disorders

Intestinal Neuronal Dysplasia Type B: An Updated Review of a Problematic Diagnosis

Contact Info

Product

Resources

About