title: Cellular and molecular basis of chronic constipation: taking the functional/idiopathic label out.
abstract: In recent years, the improvement of technology and the increase in knowledge have shifted several strongly held paradigms. This is particularly true in gastroenterology, and specifically in the field of the so-called "functional" or "idiopathic" disease, where conditions thought for decades to be based mainly on alterations of visceral perception or aberrant psychosomatic mechanisms have, in fact, be reconducted to an organic basis (or, at the very least, have shown one or more demonstrable abnormalities). This is particularly true, for instance, for irritable bowel syndrome, the prototype entity of "functional" gastrointestinal disorders, where low-grade inflammation of both mucosa and myenteric plexus has been repeatedly demonstrated. Thus, researchers have also investigated other functional/idiopathic gastrointestinal disorders, and found that some organic ground is present, such as abnormal neurotransmission and myenteric plexitis in esophageal achalasia and mucosal immune activation and mild eosinophilia in functional dyspepsia. Here we show evidence, based on our own and other authors' work, that chronic constipation has several abnormalities reconductable to alterations in the enteric nervous system, abnormalities mainly characterized by a constant decrease of enteric glial cells and interstitial cells of Cajal (and, sometimes, of enteric neurons). Thus, we feel that (at least some forms of) chronic constipation should no more be considered as a functional/idiopathic gastrointestinal disorder, but instead as a true enteric neuropathic abnormality.
authors.forename: Gabrio
authors.initials: G
authors.lastname: Bassotti
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Villanacci
authors.forename: Dragos
authors.initials: D
authors.lastname: Creţoiu
authors.forename: Sanda Maria
authors.initials: SM
authors.lastname: Creţoiu
authors.forename: Gabriel
authors.initials: G
authors.lastname: Becheanu
mesh_terms: D002908:Chronic Disease; D003106:Colon / Q000294:innervation / Q000473:pathology; D003248:Constipation / Q000145:classification* / Q000175:diagnosis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D017615:Enteric Nervous System / Q000503:physiopathology; D006801:Humans; D056885:Interstitial Cells of Cajal / Q000473:pathology; D009457:Neuroglia / Q000473:pathology; D012660:Semantics; D009626:Terminology as Topic
keywords: Constipation; Enteric glia; Enteric nervous system; Enteric neurons; Interstitial cells of Cajap; Neurogastroenterology