[1717] Biliary Dyskinesia in Children: A Mast Cell-Related Disorder?

Shree G Sharma, Ali G Saad. University of Arkansas for Medical Sciences, Little Rock; Arkansas Children's Hospital, Little Rock

Background: Studies suggest a close association between mucosal mast cells (MCs) and nerve endings. Biliary dyskinesia (BD) is a common cause of abdominal pain in children, treated with cholecystectomy. Slow gallbladder emptying is implicated as a key pathologic factor in patients with BD. We noticed increased number of MCs in the gallbladder of BD patients. This study evaluates the number of MCs in these gallbladders.
Design: The files were searched for patients with BD from 1985 to 2010. These were compared to a similar number of patients with cholelithiasis (CL). The control group was gallbladders from autopsies with no history of hepatobiliary disorder. Sections were immunostained with monoclonal mouse antihuman mast cells tryptase (clone AA1, Dako).The highest number of MCs were determined in five fields (400x) by manual count, aided by digital imaging in the lamina propria(LP) and muscularis mucosae (MM). Statistical analysis was performed using GraphPad Software (La Jolla, CA).
Results: The search resulted in 29 patients (mean age: 14.1 ± 3.8 years) with BD which were compared with 29 cholelithiasis patients (mean age: 11.4 ± 3.3 years) and 20 control patients (mean age: 10.7 ± 4.2 years). There was no statistically significant difference in age between three groups. Summary of the number and distribution of MCs is shown in Table 1.

Comparison of mast cell density between patients with biliary dyskinesia, cholelithiasis, and controls
 Biliary dyskinesiaCholelithiasisControls
Age (years)14.1 ± 3.811.4 ± 3.310.7 ± 4.2
Lamina propria15.5 ± 6.26.9 ± 2.02.3 ± 1.4
Muscularis mucosa12.8 ± 3.95.5 ± 1.61.8 ± 0.7
Numbers represent mean ± standard deviation

Patients with CL showed more MCs in LP and MM than the controls group; however, difference was not statistically significant. Patients with BD showed statistically significant increase in the number of MCs in LP and MM compared to patients with CL (P-value 2.02E-08 and 2.4E-11, respectively) and the control group (P-value 1.07E-12 and 7.75E-16, respectively).
Conclusions: The results show a marked increase in the number of MCs in the gallbladder of patients with BD as compared to patients with cholelithiasis and to normal gallbladder. Since numerous studies suggest an association between MCs and nerve twigs in the wall of various parts of the gastrointestinal system, our results suggest a pivotal role of MCs in biliary dyskinesia pathogenesis. Further investigations will develop more effective therapeutic approach for these patients.
Category: Pediatrics

Monday, February 28, 2011 1:00 PM

Poster Session II # 201, Monday Afternoon

 

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