Received: 6 January 2024 | Accepted: 15 January 2024 DOI: 10.1111/eve.13952
C L INI C A L COMMENTA RY
The subtle link between myenteric ganglionitis and inflammatory bowel disease
Valentina Vitale Universidad CEU- Cardenal Herrera, CEU Universities , Alfara del Patriarca, Valencia , Spain
Correspondence: Valentina Vitale Email:
valentina.vitale@
uchceu.es
Chronic intestinal pseudo- obstruction (CIPO) is a syndrome associ- ated with chronic or recurrent obstructive symptoms, but without an organic obstruction of the digestive tract. The first case of CIPO described in a horse dates back to the
90s when myenteric ganglionitis (MG) of unknown origin was di- agnosed in a 4- year- old mare. Subsequently, a growing number of cases have been reported, including the one described by Magalhães et al. ( 2024 ) in this issue. As anticipated by the authors of this case report, we are facing the eternal question of what came first, intesti- nal inflammation or enteric neuritis. Possibly there is no right answer as in single cases different mechanisms may lead to the same result. Partial thickness rectal or duodenal biopsies have an important lim- itation as they do not permit the evaluation of the myenteric plexus. Although a reasonable step in the work- up of a case, in patients non- responsive to classical management and with recurrent episodes of intestinal obstruction, we should not delay a full- thickness biopsy to reach a more complete diagnosis and better define the prognosis. Chronic intestinal pseudo- obstruction (CIPO) is a syndrome asso-
ciated with chronic or recurrent obstructive symptoms, but without an organic obstruction of the digestive tract (Billiauws et al., 2022 ). Disruption in smooth muscle cells (visceral myopathy), intrinsic in- testinal innervation and/or extrinsic autonomic innervation (visceral neuropathy), interstitial cell of Cajal (mesenchymopathy) act alone or together to cause severe dysmotility and related signs of CIPO (Billiauws et al., 2022 ; Downes et al., 2018 ). In humans, neuropathy is considered the most common cause of CIPO, which can be further subdivided into inflammatory or degenerative (Downes et al., 2018 ). A variety of conditions may result in inflammatory neuropathy, in- cluding autoimmune diseases, paraneoplastic syndromes, neuro- logical diseases and infections, whereby extensive cell infiltration in the neuromuscular compartment results in ganglionitis, disrupting signalling within the enteric nervous system (ENS). Degenerative neuropathy may be caused by endogenous and/or exogenous insult
to the ENS mediated by a noninflammatory response (Downes et al., 2018 ). The first case of CIPO described in a horse dates back to the
90s when myenteric ganglionitis (MG) of unknown origin was diag- nosed in a 4- year- old mare (Burns et al., 1990 ). Since then, an in- creasing number of cases have been reported (Barros et al., 2022 ; Blake et al., 2012 ; Chénier et al., 2011 ; Ortolani et al., 2021 ; Pavone et al., 2013 ), including the one described in this issue by Magalhães et al. ( 2024 ). Neurotropic viruses, such as equine herpesvirus, were suspected in most cases and confirmed in some of them (Barros et al., 2022 ; Magalhães et al., 2024 ; Pavone et al., 2013 ). Latent in- fection of EHV- 1, indeed, has been demonstrated not only in the most common locations such as trigeminal ganglion and retropha- ryngeal lymph nodes, but also in abdominal neuronal and lymphoid tissues (Giessler et al., 2020 ). However, healthy subjects rarely har- bour detectable viral DNA in the myenteric plexuses, thus the pres- ence of herpesvirus associated with MG might suggest that the virus could be related with the disease (De Giorgio et al., 2002 ; Magalhães et al., 2024 ). Interestingly, MG has also been reported in association with
Anoplocephala perfoliata (Pavone et al., 2011 ). The damage to the ENS observed by these authors may explain the altered motility and recurrent colic commonly linked to this parasite. In this case, the enteric neuropathy is considered secondary to the diffuse gut inflammation or a result of a molecular mimicry mechanism, respon- sible for an immune cross- reactivity between the parasite and the enteric neuronal cells (Ortolani et al., 2021 ; Pavone et al., 2011 ). Motility disturbances and recurrent colic are also common com- plaints in inflammatory bowel disease (IBD) cases. Similarly, the in- flammatory process of the intestine can have a detrimental effect on the myenteric ganglion and the interstitial cells of Cajal causing a subsequent form of visceral neuropathy or mesenchymopathy, as reported by others (Asakawa et al., 2022 ; Fintl et al., 2020 ).
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2024 The Authors. Equine Veterinary Education published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
Equine Vet Educ. 2024;36:289–291.
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