title: Colonic neuropathological aspects in patients with intractable constipation due to obstructed defecation.
abstract: One of the most frequent subtypes of constipation is represented by obstructed defecation, and it has recently been reported that these patients may have colonic motor abnormalities in addition to alterations of the anorectal area. However, it is unknown whether these patients display abnormalities of the enteric nervous system, as reported in other groups of constipated subjects. For this reason, we evaluated the neuropathologic aspects of the enteric nervous system in a homogeneous group of patients with obstructed defecation. Colonic specimens from 11 patients (nine women, age range 39-66 years) undergoing surgery for symptoms refractory to any therapeutic measure, including biofeedback training, were obtained and examined by means of conventional histological methods and immunohistochemistry (NSE, S100, c-Kit, formamide-mAb, Bcl-2, CD34, alfa-actin). Analysis of the specimens showed that the enteric neurons were significantly decreased only in the submucosal plexus of patients (P<0.0001 vs controls), whereas the enteric glial cells of constipated patients were reduced in both the myenteric (P=0.018 vs controls) and the submucosal plexus (P=0.004 vs controls). No difference between patients and controls were found concerning c-Kit and CD34 expression, and the number of apoptotic neurons. These findings support the concept that at least a subgroup of patients with obstructed defecation and severe, intractable symptoms display abnormalities of the enteric nervous system, mostly related to the enteric glial cells. These findings might explain some of the pathophysiological abnormalities, and help to better understand this condition.
authors.affiliation: Gastroenterology & Hepatology Section, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy. gabassot@tin.it
authors.forename: Gabrio
authors.initials: G
authors.lastname: Bassotti
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Villanacci
authors.forename: Riccardo
authors.initials: R
authors.lastname: Nascimbeni
authors.forename: Corrado R
authors.initials: CR
authors.lastname: Asteria
authors.forename: Simona
authors.initials: S
authors.lastname: Fisogni
authors.forename: Gabriella
authors.initials: G
authors.lastname: Nesi
authors.forename: Laura
authors.initials: L
authors.lastname: Legrenzi
authors.forename: Marina
authors.initials: M
authors.lastname: Mariano
authors.forename: Francesco
authors.initials: F
authors.lastname: Tonelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Morelli
authors.forename: Bruno
authors.initials: B
authors.lastname: Salerni
mesh_terms: D000368:Aged; D018952:Antigens, CD34 / Q000378:metabolism; D017209:Apoptosis; D003106:Colon / Q000294:innervation* / Q000378:metabolism / Q000473:pathology*; D003248:Constipation; D003672:Defecation; D017615:Enteric Nervous System / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007415:Intestinal Obstruction / Q000209:etiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010751:Phosphopyruvate Hydratase / Q000378:metabolism; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000378:metabolism; D019009:Proto-Oncogene Proteins c-kit / Q000378:metabolism; D009418:S100 Proteins / Q000378:metabolism
chemical_list: D018952:Antigens, CD34; D019253:Proto-Oncogene Proteins c-bcl-2; D009418:S100 Proteins; D019009:Proto-Oncogene Proteins c-kit; D010751:Phosphopyruvate Hydratase