The gastric wall in systemic sclerosis patients: a morphological study

Organ failure secondary to fi brosis is the main cause of morbidity and death in patients with
systemic sclerosis. Gastrointestinal tract dysmotility is a major visceral manifestation, clinically
ranging from an asymptomatic form to severe paresis. Although the oesophagus is the most
frequently affected part of the gastrointestinal tract, all other segments can be involved. The
present study was undertaken to evaluate the histopathological changes of the gastric wall in a
series of fullthickness
biopsies from systemic sclerosis patients who underwent gastric surgery
due to severe gastroesophageal involvement. Gastric biopsies were processed for light microscopy
and transmission electron microscopy. The histological and ultrastructural observations
revealed a generalized fi brosis affecting all the gastric wall layers. The most severe changes
were observed in the muscularis mucosae and muscle layers. Wide areas of marked focal fi brosis
with dense collagen bundles and elastic fi bre deposition surrounding smooth muscle cells
were found. Myofi laments and thickened dense bodies were severely disarranged or absent in
most smooth muscle cells. Nerve fi bres showed ultrastructural alterations, such as oedematous
axoplasm and scarce cytoskeletal elements. Abundant elastic and collagen fi bres enveloped
nerve fi bres, nerve endings and interstitial cells of Cajal, thereby separating them from smooth
muscle cells and blood microvessels. This study provides evidence for a prominent fi brosis
and severe ultrastructural alterations of smooth muscle cells and nerve fi bres as the main histopathological
hallmarks in the gastric wall of systemic sclerosis patients.