Gastrointestinal neuromuscular pathology in chronic constipation

• Published in: Baillière's best practice & research. Clinical gastroenterology Vol. 25; no. 1; pp. 43 - 57
• Main Authors: Knowles, Charles H., Farrugia, Gianrico
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.02.2011; Elsevier Limited
• Subjects: Chronic constipation; Chronic Disease; Classification; Colectomy; Colon - innervation; Colon - surgery; Constipation; Constipation - pathology; Constipation - physiopathology; Constipation - surgery; Enteric myopathy; Enteric nervous system; Enteric Nervous System - physiopathology; Enteric neuropathy; Gastroenterology and Hepatology; Gastrointestinal Transit; Histopathology; Humans; Interstial cells of Cajal; Interstitial Cells of Cajal - pathology; Muscle, Smooth - innervation; Muscle, Smooth - surgery; Pathology; Research Design; Slow-transit constipation; Smooth muscle; Studies; Surgery; Enteric nervous system; Histopathology; Enteric neuropathy; Enteric myopathy; Interstial cells of Cajal; Chronic constipation; Slow-transit constipation
• ISSN: 1521-6918; 1532-1916; 1532-1916
• DOI: 10.1016/j.bpg.2010.12.001

Some patients with chronic constipation may undergo colectomy yielding tissue appropriate to diagnosis of underlying neuromuscular pathology. The analysis of such tissue has, over the past 40 years, fuelled research that has explored the presence of neuropathy, myopathy and more recently changes in interstitial cells of Cajal (ICC). In this chapter, the data from these studies have been critically reviewed in the context of the significant methodological and interpretative issues that beset the field of gastrointestinal neuromuscular pathology. On this basis, reductions in ICC appear to a consistent finding but one whose role as a primary cause of slow-transit constipation requires further evaluation. Findings indicative of significant neuropathy or myopathy are variable and in many studies subject to considerable methodological bias. Methods with practical diagnostic utility in the individual patient have rarely been employed and require further validation in respect of normative data.