Dysplasia of the submucous nerve plexus in slow-transit constipation of adults.

AIM

A clinicopathological entity, intestinal neuronal dysplasia type B (IND) has been described in children with severe constipation. The present study was designed to evaluate whether IND could be identified in adult patients with idiopathic slow-transit constipation.

METHODS

Rectal biopsies were taken from 27 constipated patients with documented slow colonic transit and 23 controls and stained for S100 protein, acetylcholine esterase and lactate dehydrogenase. The mean and maximal number of ganglion cells per ganglion, mean number of ganglia and mean number of ganglion cells per mm2 of submucosal tissue, mean and maximal diameter of ganglion cells, maximal thickness of submucosal nerve fibres, and number of S100-positive cells per mm2 mucosal tissue were quantified. The density of submucosal ganglia, presence of heterotopic ganglion cells, intensity of staining of the adventitial layer of submucosal arteries, and density of nerve fibres in submucosa and lamina propria were evaluated qualitatively. In addition, subjective evaluation by an experienced pathologist was performed.

RESULTS

There were no major differences between patients and controls, except that patients had slightly thicker submucosal nerves than controls (30.8 +/- 1.6 versus 25.5 +/- 2.0 microm, P < 0.05) and more frequent heterotopic ganglion cells (32 versus 6%, P < 0.05). Neither discriminant analysis of the morphometric data nor subjective evaluation was able to correctly classify the slides as originating from patients or controls.

CONCLUSIONS

The existence of the clinicopathological entity IND in adults with slow-transit constipation is unlikely. For further classification of slow-transit constipation, rectal biopsies do not appear to be useful at present.