DNA viruses inthepathogenesis ofsporadic chronic idiopathic intestinal pseudo-obstruction

Background-Hereditary formsofchronic idiopathic intestinal pseudo-obstruction (CIIP) arewelldescribed buttheaetiology ofmostcasesofsporadic CIIPisunknown. Aim-To determinewhetherherpes viruses canpersist inthegastrointestinal tract, therebyimplicating theminthe pathogenesis ofCIIP. Methods-Twenty onespecimens ofsmall andlargeintestine from13patients with CIIP(eight visceral myopathy, threevisceralneuropathy, twoundifferentiated), and12patients operated onforcolorectal cancer(controls) wereexaminedforevidenceofHerpesvirus DNA (cytomegalovirus, Epstein-Barr virus(EBV),herpes simplex virustype1,andvaricella zoster virus) by nestedpolymerase chainreaction(PCR)andinsituDNA hybridisation(ISH)to localise signal to the muscularis propria ormyenteric plexus. Results-Screening with nestedPCR producedthreepatients withpositive results. Onepatient withaninflammatory visceral neuropathy hadEBV detected in thesmallintestine by PCR,and ISH demonstrated localisation toneuronesin themyenteric plexus. A patient witha visceral myopathyhadEBV DNA inboth thesmallandlargeintestine; andone patient witha visceral neuropathy had smallintestine positive forCMV DNA (bothnegative byISH).No control tissue waspositive foranyvirus. Conclusions-In individual patients there appearstobe evidence linking a viral aetiology tosporadic CIIP.The roleof neurotropic viruses inacuteandchronic motility disturbances needsfurther study. (Gut1997; 41:100-106)