Kidane Biniam, Lam Jennifer, Manji Farouq, Gupta Vaibhav, Chadi Sami A, Taylor Brian M
Western University, Schulich School of Medicine & Dentistry, London, Ontario, Canada.
Am Surg. 2015 Feb;81(2):187-92.
Gastrointestinal (GI) motility disorders are prevalent conditions associated with pain and bowel dysfunction. Some motility-disordered patients with intractable symptoms have undergone bowel resection aimed at palliating their symptoms. Our objective was to describe a population of motility-disordered patients with histopathological abnormalities identified in full-thickness surgical biopsies. A retrospective cohort study using prospectively collected clinical data and pathology reports was conducted. All adult patients referred to a tertiary motility clinic from 1996 to 2011 who had bowel resection for motility disorder were consecutively sampled. Fisher's exact test was used. Ninety-seven patients were referred for motility disorder during this time and pathology reports were available for 62 patients (63.9%). Hypertrophy or hyperplasia of the myenteric plexus was reported in 13 patients (21.0%). These patients were predominantly females with constipation-dominant symptoms. They were more likely to have objective evidence of colonic inertia (P = 0.01) than patients without myenteric plexus hypertrophy/hyperplasia. Consistent histopathologic abnormalities of myenteric plexus hypertrophy/hyperplasia were described in 21 per cent of patients with refractory GI motility disorders referred for surgical management. Our findings contrast with the hypoganglionosis reported in the slow transit constipation literature. Future studies are needed to systematically investigate these novel histologic findings through a follow-up immunohistochemical study of stored bowel specimens.
胃肠（GI）动力障碍是与疼痛和肠道功能紊乱相关的常见病症。一些有顽固性症状的动力障碍患者接受了旨在缓解症状的肠切除术。我们的目的是描述一组在全层手术活检中发现有组织病理学异常的动力障碍患者。我们进行了一项回顾性队列研究，使用前瞻性收集的临床数据和病理报告。对1996年至2011年期间转诊至三级动力诊所因动力障碍接受肠切除术的所有成年患者进行连续抽样。采用Fisher精确检验。在此期间，有97名患者因动力障碍前来就诊，62名患者（63.9%）有病理报告。13名患者（21.0%）报告有肌间神经丛肥大或增生。这些患者主要为女性，以便秘为主症。与没有肌间神经丛肥大/增生的患者相比，她们更有可能有结肠无力的客观证据（P = 0.01）。在因手术治疗而转诊的难治性胃肠动力障碍患者中，21%的患者存在一致的肌间神经丛肥大/增生组织病理学异常。我们的发现与慢传输型便秘文献中报道的神经节减少症形成对比。需要进一步的研究通过对储存的肠道标本进行后续免疫组织化学研究来系统地调查这些新的组织学发现。
