title: Decreased substance P levels in rectal biopsies from patients with slow transit constipation.
abstract: OBJECTIVE
  Previous studies in patients with chronic constipation found abnormalities in the nervous tissue of the large intestine, predominantly in the muscularis externa. Since there is evidence that the nervous system of mucosa and submucosa is also involved in the control of colonic motility we investigated the contents of vasoactive intestinal polypeptide (VIP), somatostatin and substance P in rectal biopsies of patients with slow colonic transit constipation.
  
  
  METHODS
  Twenty-two patients (17 females, 5 males) with chronic slow transit constipation (oro-anal transit with radio-opaque markers on high fibre diet > 70 h) and long-term use of laxatives, and 20 controls (12 females, 8 males) with no history of constipation, were included in this study. Large rectal biopsy specimens including the submucosa were obtained from 5 cm above the dentate line and frozen in liquid nitrogen. After microdissection of the biopsies into mucosa and submucosa the neuropeptides were extracted by boiling and homogenizing the tissue in acetic acid and determined using validated radioimmunoassays.
  
  
  RESULTS
  Patients with slow transit constipation showed, compared to healthy controls, significantly lower levels of the excitatory neurotransmitter substance P in the mucosa and submucosa of rectal biopsies. There was no difference between the two groups concerning the levels of the inhibitory neurotransmitters, VIP and somatostatin.
  
  
  CONCLUSIONS
  Slow transit constipation is associated with abnormalities of the substance P content of the enteric nervous system of mucosa and submucosa. This seems not to be related to chronic laxative use, since anthranoids cause a reduction in the levels of inhibitory neurotransmitters (VIP, somatostatin), but not of substance P, in the rat colon.
authors.affiliation: Medizinische Klinik, Klinikum Innenstadt, University of Munich, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Tzavella
authors.forename: R L
authors.initials: RL
authors.lastname: Riepl
authors.forename: A G
authors.initials: AG
authors.lastname: Klauser
authors.forename: W A
authors.initials: WA
authors.lastname: Voderholzer
authors.forename: N E
authors.initials: NE
authors.lastname: Schindlbeck
authors.forename: S A
authors.initials: SA
authors.lastname: Müller-Lissner
mesh_terms: D001706:Biopsy; D016022:Case-Control Studies; D003248:Constipation / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology; D017615:Enteric Nervous System / Q000378:metabolism* / Q000503:physiopathology; D005260:Female; D005772:Gastrointestinal Transit / Q000502:physiology; D006801:Humans; D007413:Intestinal Mucosa / Q000737:chemistry / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011863:Radioimmunoassay; D012007:Rectum / Q000737:chemistry / Q000473:pathology*; D013004:Somatostatin / Q000032:analysis; D013373:Substance P / Q000032:analysis*; D014660:Vasoactive Intestinal Peptide / Q000032:analysis
chemical_list: D013373:Substance P; D014660:Vasoactive Intestinal Peptide; D013004:Somatostatin