The gastric wall in systemic sclerosis patients: a morphological study.

Area of Science:

• Gastroenterology
• Rheumatology
• Pathology

Background:

• Systemic sclerosis (SSc) is a multisystem autoimmune disease characterized by fibrosis.
• Gastrointestinal dysmotility is a common and severe manifestation of SSc, impacting patient morbidity and mortality.
• Gastric involvement in SSc can lead to severe gastroesophageal dysfunction requiring surgical intervention.

Purpose of the Study:

• To investigate the histopathological changes in the gastric wall of patients with systemic sclerosis and severe gastroesophageal involvement.
• To evaluate the ultrastructural alterations in smooth muscle cells and nerve fibers within the gastric wall.

Main Methods:

• Analysis of full-thickness gastric biopsies from SSc patients undergoing surgery.
• Histopathological examination using light microscopy and transmission electron microscopy.

Main Results:

• Generalized fibrosis was observed throughout all layers of the gastric wall, with pronounced changes in the muscularis mucosae and muscle layers.
• Smooth muscle cells exhibited disarranged or absent myofilaments and thickened dense bodies.
• Nerve fibers showed ultrastructural alterations, including oedematous axoplasm and reduced cytoskeletal elements, ensheathed by abundant collagen and elastic fibers.
• Interstitial cells of Cajal were also enveloped by connective tissue, potentially disrupting cell-to-cell communication.

Conclusions:

• Prominent fibrosis and severe ultrastructural alterations of smooth muscle and nerve components are the primary histopathological hallmarks in the gastric wall of systemic sclerosis patients.
• These findings contribute to understanding the pathophysiology of SSc-associated gastrointestinal dysmotility.