An immunohistochemical study of the myenteric plexus in idiopathic achalasia.

BACKGROUND: Achalasia is a primary esophageal motor disorder characterized by degenerative changes of the myenteric plexus. The pathophysiologic abnormalities may be the final result of several intermeshing mechanisms, and more than one single factor may cause the motor abnormalities. AIMS: To report our experience in investigating the myenteric plexus of achalasia patients undergoing esophagomyotomy. PATIENTS AND METHODS: Tissue samples from 12 patients undergoing Heller myotomy for achalasia were evaluated and compared with esophageal tissue specimens from 7 controls. Enteric neurons and interstitial cells of Cajal (ICC) were assessed by immunohistochemical methods, and the presence of vasoactive intestinal polypeptide ergic fibers and of CD3 lymphocytes. The possible presence of herpesvirus was also assessed by immunohistochemistry, whereas that of papillomavirus was assessed by in-situ hybridization. RESULTS: Compared with controls, achalasia patients displayed a significant decrease of both enteric neurons and ICC. Immunoreactivity for vasoactive intestinal polypeptide was completely absent in each patient. CD3 staining disclosed myenteric plexitis in 5 (42%) patients; no control patient had plexitis. All patients were completely negative for the presence of both herpes simplex virus and human papillomavirus. CONCLUSIONS: The enteric nervous system of the lower esophageal sphincter area is impaired in patients with "idiopathic achalasia," and the abnormalities involve ICC and neurons in many patients. The triggering factors for these abnormalities are, however, still unknown.

Novel soy germ pasta improves endothelial function, blood pressure, and oxidative stress in patients with type 2 diabetes.

OBJECTIVE: To compare the effects of a novel soy germ-enriched pasta, containing isoflavone aglycons, with conventional pasta on endothelial function and cardiovascular risk markers in patients with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS: This randomized controlled double-blind crossover study compared one serving/day of soy germ pasta and conventional pasta for 8 weeks for effects on brachial artery flow-mediated vasodilation, blood pressure, plasma lipids, oxidized LDL cholesterol, 8-iso-PGF2α, total antioxidant capacity (TAC), glutathione (GSH), and homocysteine. RESULTS: Isoflavone-enriched pasta significantly improved arterial stiffness (P = 0.005) and reduced systolic (P = 0.026) and diastolic (P = 0.017) blood pressures. Plasma TAC increased (P = 0.0002), oxidized LDL cholesterol decreased (P = 0.009), 8-iso-PGF2α decreased (P = 0.001), GSH levels increased (P = 0.0003), and homocysteine decreased (P = 0.009) consistent with a reduction in oxidative stress. No significant changes were observed with conventional pasta. CONCLUSIONS: Pasta enriched with biologically active isoflavone aglycons improved endothelial function and had beneficial effects on cardiovascular risk markers in patients with T2D.

Enteric neuroglial apoptosis in inflammatory bowel diseases.

BACKGROUND: Enteric nervous system abnormalities have been described in patients with inflammatory bowel diseases. However, the mechanisms responsible for these abnormalities remain to date largely unknown. AIMS: We investigated the potential role of apoptotic phenomena in enteric neurons and enteroglial cells in patients with inflammatory bowel diseases. PATIENTS AND METHODS: Full-thickness surgical specimens of 19 patients undergoing surgery for medically refractory disease (9 from the ileum of patients with Crohn's disease, 10 from the colon of patients with ulcerative colitis) were assessed for the presence of enteric neurons and enteroglial cells and for their apoptosis by two immunohistochemical methods, one also able to distinguish apoptosis from necrosis. The results were compared with those obtained in control specimens. RESULTS: Concerning Crohn's disease, the ileal segments displayed a significant increase of apoptotic enteric neurons and enteroglial cells in both the submucous and the myenteric plexus compared to controls. In patients with ulcerative colitis, compared to controls, apoptotic phenomena were significantly reduced in enteric neurons, whereas they were increased in the enteroglial cell population (submucous and myenteric plexus). CONCLUSIONS: In patients with inflammatory bowel disease apoptotic phenomena involve both enteric neurons and enteroglial cells, and may play a role in the abnormalities of the enteric nervous system. The importance of these findings in the pathophysiology of these conditions remains to be determined.