Background In Systemic Sclerosis (SSc) the gastrointestinal (GI) involvement leads to hypomotility and dysphagia at esophageal level and severe constipation of the colon,1,2 even if other segments of GI are known to be affected in subclinical form.
Objectives Few studies have assessed the morphological features of the stomach in SSc. A 52 years old female with limited SSc from 1979, suffering from dysphagia, pyrosis, epigastric pain, gastro-esophageal reflux, in 1998, underwent to distal esophagectomy for Barrett?s oesophagus and, in 1999, to total gastrectomy with Roux y esophago-jejunal anastomosis. The stomach appeared very small, shrunken, its wall being stiff and increased in consistence. Samples were taken to study the ultrastructural modifications of the gastric wall and, in particular, the muscle coat.
Methods Samples of the gastric anterior wall from fundus, corpus and antrum, along the greater curvature, were obtained. The specimens were fixed in 4% glutaraldehyde in 0,1 M phosphate buffer, postfixed in 1% osmium tetroxide in 0,1M phosphate buffer and routinely processed for transmission electron microscopic observation. The ultrathin sections (1 μm) were stained with uranyl acetate and alkaline bismuth subnitrate and observed under Jeol 1010 electron microscope.
Results Wide focal areas of fibrosis, characterised by collagen fibres depositions, surrounding smooth muscle cells (SMC) were found. Many SMC were hypercontracted and/or showed a severe disarrangement of the myofilaments. Often, the dense bodies and the dense bands were thickened. Some SMC showed cytoplasmic vacuolisation and swollen mithocondria. Nerve bundles containing many axons were close to vessels and SMC. The axoplasms of nerve fibres were oedematous and poor in neurotubules and filaments, but the nerve endings close to SMC showed normal morphology, with the presence of synaptic vescicles, whose number was seldom decreased. Blood vessels were lined by intact endothelial cells, while the basement membrane appeared or thickened and laminated. The lumen was partially or completely occluded by erythrocytes and neutrophils. Inflammatory infiltrate as well, and many mast cells rich in granules or partially degranulated, were close to vessels and SMC.
Conclusion In the muscle coat of stomach focal fibrosis, severe ultrastructural modification of SCM and mild nerve fibres involvement are evident, without signs of endothelial damage.
Russell LM, et al. Ultrastructure of the esophagus in scleroderma. Arthritis Rheum. 1982;25:1117–2
Malandrini A, et al. Autonomic nervous system ansd smooth muscle cell involvement in systemic sclerosis: ultrastructural study of three cases. J Rheumatol. 2000;27:1203–6
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