Intestinal neuronal dysplasia type B: A still little known diagnosis for organic causes of intestinal chronic constipation.
Intestinal neuronal dysplasia type B (IND-B) is a controversial entity among the gastrointestinal neuromuscular disorders. It may occur alone or associated with other neuropathies, such as Hirschsprung's disease (HD). Chronic constipation is the most common clinical manifestation of patients. IND-B primarily affects young children and mimics HD, but has its own histopathologic features characterized mainly by hyperplasia of the submucosal nerve plexus. Thus, IND-B should be included in the differential diagnoses of organic causes of constipation. In recent years, an increasing number of cases of IND-B in adults have also been described, some presenting severe constipation since childhood and others with the onset of symptoms at adulthood. Despite the intense scientific research in the last decades, there are still knowledge gaps regarding definition, pathogenesis, diagnostic criteria and therapeutic possibilities for IND-B. However, in medical practice, we continue to encounter patients with severe constipation or intestinal obstruction who undergo to diagnostic investigation for HD and their rectal biopsies present hyperganglionosis in the submucosal nerve plexus and other features, consistent with the diagnosis of IND-B. This review critically discusses aspects related to the disease definitions, pathophysiology and genetics, epidemiology distribution, clinical presentation, diagnostic criteria and therapeutic possibilities of this still little-known organic cause of intestinal chronic constipation.
Pedro Luiz Toledo de Arruda Lourenção, Erika Veruska Paiva Ortolan, Department of Surgery and Orthopedics, Botucatu Medical School - Unesp, Botucatu, São Paulo 18618-687, Brazil.
Pedro Luiz
PL
Toledo de Arruda Lourenção
Pedro Luiz Toledo de Arruda Lourenção, Erika Veruska Paiva Ortolan, Department of Surgery and Orthopedics, Botucatu Medical School - Unesp, Botucatu, São Paulo 18618-687, Brazil.
Simone Antunes
SA
Terra
Pedro Luiz Toledo de Arruda Lourenção, Erika Veruska Paiva Ortolan, Department of Surgery and Orthopedics, Botucatu Medical School - Unesp, Botucatu, São Paulo 18618-687, Brazil.
Erika Veruska Paiva
EV
Ortolan
Pedro Luiz Toledo de Arruda Lourenção, Erika Veruska Paiva Ortolan, Department of Surgery and Orthopedics, Botucatu Medical School - Unesp, Botucatu, São Paulo 18618-687, Brazil.
Maria Aparecida Marchesan
MA
Rodrigues
Dysganglionosis; Gastrointestinal neuromuscular diseases; Hyperplasia of the submucosal nerve plexus; Intestinal chronic constipation; Intestinal neuronal dysplasia type B