Colonic neuropathological aspects in patients with intractable constipation due to obstructed defecation

被引:37
作者
Bassotti, Gabrio
Villanacci, Vincenzo
Nascimbeni, Riccardo
Asteria, Corrado R.
Fisogni, Simona
Nesi, Gabriella
Legrenzi, Laura
Mariano, Marina
Tonelli, Francesco
Morelli, Antonio
Salerni, Bruno
机构
[1] Univ Perugia, Gastroenterol & Hepatol Sect, Dept Clin & Expt Med, I-06100 Perugia, Italy
[2] Univ Brescia, Pathol Unit 2, Dept Pathol, Brescia, Italy
[3] Univ Brescia, Surg Chair 2, Dept Surg, Brescia, Italy
[4] Univ Florence, Surg Unit, Dept Clin Pathophysiol, Florence, Italy
[5] Univ Florence, Pathol Unit, Dept Human Pathol & Oncol, Florence, Italy
关键词
constipation; enteric glial cells; enteric nervous system; outlet obstruction;
D O I
10.1038/modpathol.3800748
中图分类号
R36 [病理学];
学科分类号
100104 [病理学与病理生理学];
摘要
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.
引用
收藏
页码:367 / 374
页数:8
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