Chronic intestinal pseudo-obstruction

Table 1 Main causes of secondary chronic idiopathic pseudo-obstruction and relative gut tissue that is predominantly involved

Underlying disease	Main causes
Diseases of central autonomic and enteric nervous systems	Stroke, encephalitis, calcification of basal ganglia, orthostatic hypotension, Von Recklinghausen, Hirschsprung
Immune-mediated and collagen diseases	Paraneoplastic (CNS neoplasms, lung microstoma, bronchial carcinoid, leyomyosarcomas), scleroderma, dermatomyositis, amyloidosis, Ehlers-Danlos, LES
Endocrine and metabolic diseases	Diabetes, hypothyroidism, hypoparathyroidism, phaeochromocytoma
Other	Iatrogenic (radiation enteritis, clonidine, phenothiazines, antidepressants, antiparkinsonians, antineoplastics, bronchodilators, anthraquinones) jejunal diverticulosis, chagas

Table 2 Immunohistochemical markers to analyze full thickness biopsy of patients with CIPO

Markers	Cell targets and sites	Description
PGP9.5, NSE, MAP-2, NFs, tubulins, Hu C/D	Neurons: Membrane/Cytoplasmic	Identification of the general structure of the ENS
β-S-100, GFAP	Glial cells: Cytoplasmic	Detection of enteroglial cells
Kit	Interstitial cells of Cajal: Membrane/Cytoplasmic	Different ICC networks
SP, VIP, PACAP, CGRP, NPY, Galanin, 5-HT, NOS, ChAT, somatostatin, Calbindin, NeuN, NK1, NK2 and NK3	Subclasses of enteric neurons; interstitial cells of Cajal: Membrane/Cytoplasmic	Characterization of neurochemical coding and enteric neuron subclasses; subsets of interstitial cells of Cajal
Bcl-2, TUNEL, Caspase-3, Caspase-8, Apaf-1	Apoptosis and related mechanisms:Nuclear/Cytoplasmic	Assessment of apoptosis and related pathways
Actin, myosin, desmin, smoothelin	Smooth muscle cells: Cytoplasmic	Assessment of smooth muscle integrity
CD3, CD4, CD8, CD79α, CD68; MIP-1α, TNF-α, IFN-γ	Immune cells, chemokines and cytokines: Membrane/Cytoplasmic	Evaluation of B (CD79α) and T-lymphocytes (CD3), T-helper (CD4), T-suppressor (CD8), macrophages (CD68) in enteric ganglionitis; MIP-1α is a chemokine; TNF-α and IFN-γ are inflammatory cytokines

Bcl-2: B cell lymphoma-2 protein; ChAT: Choline acetyltransferase; CGRP: Calcitonin gene-related peptide; ENS: Enteric nervous system; GFAP: Glial fibrillary acidic protein; Hu C/D: Hu C/D molecular antigen; IFN-γ: Interferon γ; MAP-2: Microtubule associated protein-2; MIP1-α: Macrophage inflammatory protein-1α; NeuN: Neuronal-specific nuclear protein; NFs: Neurofilaments; NK1, NK2, NK3: Neurokinin1, neurokinin2, neurokinin3; NOS: Nitric oxide synthase; NPY: Neuropeptide Y; NSE: Neuron-specific enolase; PACAP: Pituitary adenylate cyclase activating polypeptide; PGP9.5: Protein gene product 9.5; 5-HT: 5-hydroxytryptamine (serotonin); SP: Substance P; TNF-α: Tumor necrosis factor α; Tubulins: Cytoskeletal proteins; TUNEL: Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling; VIP: Vasoactive intestinal polypeptide.