Full-thickness biopsy of the jejunum reveals inflammation and enteric neuropathy in irritable bowel syndrome Hans Törnblom, Greger Lindberg, Björn Nyberg,

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Full-thickness biopsy of the jejunum reveals inflammation and enteric neuropathy in irritable bowel syndrome Hans Törnblom, Greger Lindberg, Björn Nyberg, Béla Veress Gastroenterology Volume 123, Issue 6, Pages 1972-1979 (December 2002) DOI: 10.1053/gast.2002.37059 Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 1 Control ileum with normal number of intraepithelial lymphocytes (arrows). (CD3 immunoperoxidase; original magnification ×380.) Gastroenterology 2002 123, 1972-1979DOI: (10.1053/gast.2002.37059) Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 2 Proximal jejunum with increased number of intraepithelial lymphocytes (arrows) (41 IELs/100 epithelial cells). (CD3 immunoperoxidase; original magnification ×380.) Gastroenterology 2002 123, 1972-1979DOI: (10.1053/gast.2002.37059) Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 3 Normal myenteric ganglion. The neurons show normal cytomorphology with moderate or slight eosinophilic and finely granular cytoplasm. Note that there is no vaculization or deeply stained, dark cytoplasm. The nuclei are round with well-visible nucleoli. No signs of nuclear shrinkage or homogeneous dark basophilia of the chromatin as in pyknotic (shrunken) degenerating nuclei. The small, round nuclei belong to glia cells (thin arrows), whereas the elongated pale nucleus is that of a Schwann cell (thick arrow). (H&E; original magnification ×380.) Gastroenterology 2002 123, 1972-1979DOI: (10.1053/gast.2002.37059) Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 4 Lymphocyte infiltrate within myenteric ganglion. Thick arrow shows a neuron and a few lymphocytes to the right of the neuron. There are more lymphocytes within the area marked by thin arrows. (H&E; original magnification ×380.) Gastroenterology 2002 123, 1972-1979DOI: (10.1053/gast.2002.37059) Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 5 There is a focus of T lymphocytes within the myenteric ganglion marked by thin arrows. Thick arrow: neuron. (CD3 immunoperoxidase; original magnification ×380.) Gastroenterology 2002 123, 1972-1979DOI: (10.1053/gast.2002.37059) Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 6 Degenerative neuropathy. Myenteric ganglion with 2 shrunken degenerated neurons marked by thin arrows. The cytoplasm is vacuolated and the nuclei are pyknotic. One normal neuron is shown by a thick arrow. (H&E; original magnification ×380.) Gastroenterology 2002 123, 1972-1979DOI: (10.1053/gast.2002.37059) Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 7 Normal muscularis propria. The inner circular layer (C) is considerably thicker than the outer longitudinal muscle layer (L) (bar = 200 μm). (H&E) Gastroenterology 2002 123, 1972-1979DOI: (10.1053/gast.2002.37059) Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 8 The thickness of the 2 muscle layers are equal because of a thickened longitudinal muscle layer (L) secondary to hypertrophy of the myocytes (C, inner circular muscle layer). (Desmin immunoperoxidase; original magnification ×140.) Gastroenterology 2002 123, 1972-1979DOI: (10.1053/gast.2002.37059) Copyright © 2002 American Gastroenterological Association Terms and Conditions