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Background and Aims: Small bowel manometry is increasingly used in the clinical investigation of patients with symptoms of intestinal motor dysfunction. Enteric dysmotility (ED) has been suggested as a new diagnostic term for patients with abnormal intestinal motor activity but no radiological signs of chronic intestinal pseudo-obstruction (CIP). Histopathological features of adult patients with ED and CIP have been compared in a large case series to study differences and similarities between the two diagnostic groups. Methods: Routine staining and an extensive panel of immunohistochemical stains on transversal and tangential cuts from full-thickness biopsies of the small bowel were used. Results: 39 females and 11 males with CIP and 58 females and 7 males with ED were investigated. The underlying lesion was more often a visceral myopathy (22% vs 5%) or neuromyopathy (30% vs 12%) in patients with CIP than in those with ED, whereas the predominant lesion in ED was neuropathy with inflammation. Conclusion: CIP in adults is associated with very different underlying pathology, whereas ED is more homogeneously associated with neuropathy in the enteric nervous system. Neuropathy of enteric ganglia with inflammation seems to be the most common cause for measurable disturbances of intestinal motor function.

Adult acquired chronic intestinal pseudo-obstruction (CIP) has mainly been attributed to secondary forms of pseudo-obstruction associated with systemic inflammatory disorders such as progressive systemic sclerosis and systemic lupus erythematosus, endocrine disorders and neurological disorders. However, recent case series from large tertiary centres have described adults without any known predisposing disease, so-called idiopathic CIP.1 2 In this issue of Gut , Selgrad et al ( see page 25 )3 report their findings of JC (John Cunningham) virus proteins in glial cells of the myenteric plexus in 7/10 adult patients with idiopathic CIP. These findings seem to implicate a role for JC virus, a DNA virus that belongs to the family of polyomaviruses, in the pathogenesis of CIP. JC virus is the causative agent in progressive multifocal leucoencephalopathy (PML),4 a disease that almost exclusively occurs in immnocompromised patients. Today HIV/AIDS is the most prevalent state of deficient cell-mediated immunity associated with a risk for developing PML. In recent years PML has also occurred in patients treated with certain biological drugs such as natalizumab, an antibody against the cellular adhesion molecule α4-integrin, and rituximab, an antibody against the cluster of differentiation 20 (CD20), which is widely expressed on the surface of B cells.5 Reactivation of a latent JC virus infection is believed to be the main mechanism by which the virus ultimately can …