Gastrointestinal neuromuscular pathology in chronic constipation

Abstract

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, fueled 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.

Figure 1

Colonic sections from patient with STC and control immunostained using antibody to CD117 (c-kit). There is a significant (>50%) reduction in ICC within the circular muscle in the patient with STC" Scale bar = 25 μm. Images were collected on the LSM 510 using a 40X Zeiss water immersion objective