Serologic profiles aiding the diagnosis of autoimmune gastrointestinal dysmotility
Open accessAbstract
Background & aims Autoimmune gastrointestinal dysmotility is a limited autoimmune dysautonomia occurring idiopathically or in the context of an anatomically remote neoplasm, previously documented or unsuspected. Here we report 24 Mayo Clinic patients in whom the profile of serum autoantibodies aided this diagnosis. Methods All patients were ascertained serologically in the course of service evaluation for autoantibodies consistent with neurologic autoimmunity. Review of their histories, motility studies, and laboratory findings revealed that all had presented with subacute gastrointestinal dysmotility. Results Recorded motility abnormalities included esophageal dysmotility 8 (6 had achalasia), delayed gastric emptying 12, slow small intestinal transit 7, slow colonic transit 4, and pelvic floor dyssynergia 4. Four patients underwent abdominal surgery; 2 commenced total parenteral nutrition. Plasma membrane cation channel autoantibodies were detected in 23 patients: neuronal voltage-gated calcium channel (5 N-type and 1 P/Q-type), acetylcholine receptor (11 ganglionic-type and 4 muscle-type), and neuronal voltage-gated potassium channel autoantibodies (4). Two patients had antineuronal nuclear autoantibodies, type 1. Approximately half of the patients had neural autoantibodies (including skeletal muscle striational and glutamic acid decarboxylase, 65kd isoform) or other antibody markers of organ-specific autoimmunity (thyroid or gastric parietal cell specificities). Neoplasia was diagnosed in 11 patients (9 recent, 2 remote): lung, breast and endometrial, gastrointestinal and thymoma. Moderate to dramatic improvement in gastrointestinal symptoms was reported after immunotherapy in 4 of 4 patients treated and after pyridostigmine treatment in 2 of 2 patients treated. Conclusions Autoimmune serology aids the diagnosis of autoimmune gastrointestinal dysmotility, both paraneoplastic and idiopathic, and might guide management.
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In cohorts of patients with idiopathic, paraneoplastic, or diabetic autonomic neuropathy and in idiopathic GI dysmotility, ganglionic receptor-binding antibody titers have correlated with more severe autonomic dysfunction.
“In cohorts of patients with idiopathic, paraneoplastic, or diabetic autonomic neuropathy and in idiopathic GI dysmotility, ganglionic receptor-binding antibody titers have correlated with more severe autonomic dysfunction (Dhamija et al., 2008; Pittock et al., 2011).”
From Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction (2026) · cites this paper as Dhamija et al., 2008
The Introduction says ganglionic AChR antibodies can cause widespread autonomic dysfunction, and the Results report these antibodies in 11 patients with GI dysmotility. But the paper does not report a correlation between antibody titer and autonomic dysfunction severity, or examine the stated idiopathic, paraneoplastic, and diabetic autonomic-neuropathy cohorts (searched for titer, severity, and diabetic autonomic neuropathy). Page numbers were unavailable in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredAutoantibodies directed against specific neural antigens, including ion channels and ganglionic acetylcholine receptors, have been associated with esophageal dysmotility, slow-transit constipation, and chronic intestinal pseudo-obstruction.
“Autoantibodies directed against specific neural antigens (including ion channels and ganglionic acetylcholine receptors) have been associated with esophageal dysmotility, slow-transit constipation, and chronic intestinal pseudo-obstruction.”
From Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction (2026) · cites this paper as Dhamija et al., 2008
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- Authors
- Dhamija, R., Tan, K. M., Pittock, S. J., Foxx–Orenstein, A., Benarroch, E., & Lennon, V. A.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Lennon, Vanda A.
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2008-09
- Volume
- 6
- Issue
- 9
- Pages
- 988-992
- ISSN
- 1542-3565 (ISSN-L)
- PMC
- PMC2741093
- OpenAlex
- W2096265245
- Cited by
- 114
- References
- 24
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 10 · 2023: 7 · 2022: 8 · 2021: 14 · 2020: 7 · 2019: 8 · 2018: 10 · 2017: 3 · 2016: 4 · 2015: 7 · 2014: 3 · 2013: 1 · 2012: 3
- FWCI
- 4.06
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (DK-68055, P01DK068055)
- Topics
- Health Sciences › Medicine › Neurology › Autoimmune Neurological Disorders and Treatments
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Neurology › Peripheral Neuropathies and Disorders
- Keywords
- autoantibodies, acetylcholine receptor antibodies, glutamic acid decarboxylase antibodies, achalasia, delayed gastric emptying, small intestinal transit, colonic transit, pelvic floor dyssynergia, paraneoplastic syndrome, esophageal motility, immunotherapy, pyridostigmine, thymoma
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Autoantibodies, Autoimmune Diseases, Autonomic Nervous System Diseases, Diagnosis, Differential, Female, Gastric Emptying, Gastrointestinal Motility, Gastrointestinal Transit, Humans, Immunotherapy, Intestinal Diseases, Male, Middle Aged, Neoplasms, Serologic Tests, Esophageal Motility Disorders
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