Severe Idiopathic Constipation Is Associated With a Distinctive Abnormality of the Colonic Myenteric Plexus

Krishnamurthy, Shoba; Schuffler, Michael D.; Rohrmann, Charles A.; Pope, Charles E.

doi:10.1016/s0016-5085(85)80128-1

Cited by 277 publications

(117 citation statements)

References 23 publications

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“…Patients with abnormalities of colonic transit respond poorly to traditional oral pharmaceutical preparation after ARM [1][2][3][4] , and those with colonic inertia such as a redundant colon and colonic diverticula have impaired colon motility [23][24][25] . Arhan et al 26) reported that anal stenosis is associated with abnormal function of rectum and the anal sphincter.…”

Section: Results After Arm In Patients With the Other Causes Of Chronmentioning

confidence: 99%

“…Patients with ultrashort or short type of HD and its allied disorders often have bowel movements less than 1 to 3 times per week despite the use of medical therapy and/or dietary manipulation, and symptoms (soiling, abdominal pain, anal pain, and so on) dominate the patient's life style [1][2][3][4] . Almost patients before ARM complained of infrequent bowel habit less than 3 times per week, and difficulty in defecation despite the use of medical therapy such as suppositories, enemas, or anal dilatation.…”

Section: Clinical Characteristics Before and After Arm In Patients Wimentioning

confidence: 99%

“…However, these symptoms are difficulty to quantify 1,2) . In general, stool frequency reported that patients with chronic constipation often have stool frequencies of less than once per week despite the use of fiber and/or laxatives 3) . Stivland et al 4) also showed that chronic nonspecific constipation (i.e., Chronic constipation) is defined as a frequency of bowel motions less than three times per week and a resulting failure to respond to medical management for more than 6 months.…”

Section: Introductionmentioning

confidence: 99%

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Is Anorectal Myectomy useful for Hirschsprung’s Disease and its Allied Disorders?

Ryouichi

2017

Nichidai Igaku Zasshi

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The author reviewed the clinical features of children with Hirschsprung's disease (HD) and its allied disorders [hypoganglionosis (Hypo) and intestinal neuronal dysplasia (IND)] before and after anorectal myectomy (ARM). The incidence was greater in males than in females (1.5:1). The patients were between 0 and 15 years of age and more than half were less than 6 years old. Neurohistochemical examination showed Hypo [mild type (3/5 or more ganglion cells per ganglia compared with normal ganglia), severe type (less than 2/5 ganglion cells per ganglia compared with normal ganglia), IND, and HD (aganglionosis). Mild Hypo was the most common, compared with HD and NID. Abdominal pain was the most common symptom, followed by soiling and anal pain. Spontaneous evacuation without the need for laxatives was noted in 70~75% patients with a good outcome, and 30~40% of those with a satisfactory outcome after ARM. Patients with a poor outcome still required laxatives and other medical treatment. Related causes of constipation, i.e., colonic inertia, psychological or central nervous disorders, occurred at a higher incidence in those with a poor outcome. The most common related cause of constipation after ARM was colonic inertia, i.e., redundant colon. Additional operations (subtotal colectomy and ileorectal anastomosis) were performed for the patients with a poor outcome. These patients were satisfied with the postoperative state of evacuation. In conclusion, the abnormal distribution of ganglia, i.e. Hypo, IND, and HD could be largely related to the defecation disorders observed in childhood patients with chronic constipation. Patients with severe Hypo, IND, and HD, especially those with long affected colon, psychological or central nervous disorders, may experience significant persistent constipation after ARM. Additional operations should be performed in patients with a poor outcome due to colonic inertia.

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Section: Results After Arm In Patients With the Other Causes Of Chronmentioning

confidence: 99%

Section: Clinical Characteristics Before and After Arm In Patients Wimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is Anorectal Myectomy useful for Hirschsprung’s Disease and its Allied Disorders?

Ryouichi

2017

Nichidai Igaku Zasshi

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“…1,18 The etiology for obstruction has been adhesions resulting from the extensive colectomy and a proposed neuropathic disorder of the myenteric plexus affecting bowel motility. 1,19 The recent use of antiadhesive agents such as Seprafilm 1 may reduce the incidence of this complication.…”

Section: Complicationsmentioning

confidence: 99%

Surgical Management of Constipation

Beck

2005

Clinics in Colon and Rectal Surgery

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For the select small number of constipated patients who cannot be managed medically, surgical options should be considered. Increases in our knowledge of colorectal physiology and experience have fostered improvements in evaluation and surgical management of patients. Currently, patients with refractory colonic inertia are offered total abdominal colectomy and ileorectal anastomosis. With proper selection of patients, the results have been excellent for resolving the frequency and quality of bowel movements. However, symptoms such as bloating and abdominal pain, which may be related to irritable bowel syndrome rather than the colonic inertia, may persist.

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“…Clinical symptoms can include low stool frequency, lack of urge to defecate, abdominal distention, bloating, and abdominal discomfort [1] . Although the pathophysiology has not yet been fully understood, visceral neuropathies [2] , dysregulation of neurotransmitters [3] , degeneration of enteric neurons [4] , and alterations of interstitial cells of Cajal (ICCs) [5] are possible etiological mechanisms that have been discussed in the literature [6] . ICCs form a network that is widely distributed in all layers of the gastrointestinal tract.…”

Section: Introductionmentioning

confidence: 99%

Therapy-refractory gastrointestinal motility disorder in a child with c-kit mutations

Breuer

Oh²,

Molderings³

et al. 2010

WJG

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Constipation and fecal impaction are frequent and distressing complaints in pediatric gastroenterology. Especially in neurologically handicapped children, treatment of severe forms of slow-transit constipation (STC) can be difficult. In the majority of cases, STC is of unknown etiology. However, in recent years, there is growing evidence that interstitial cells of Cajal (ICCs), which serve as electrical pacemakers and generate spontaneous electrical slow waves in the gastrointestinal tract, might play an important role in the pathophysiology of STC. It remains unclear whether morphological ICC alterations seen in affected patients are based on congenital developmental anomalies, or whether they are a consequence of long-term constipation with secondary damage of the gastrointestinal nervous system. To the best of our knowledge, we present the first case of a patient with histological alterations in ICC morphology who displayed multiple alterations of c-kit at the level of mRNA. The protein encoded by c-kit is the receptor tyrosine kinase Kit (CD117), which is crucial for development and function of ICCs. Therefore, these findings provide a new explanation for congenital alterations of ICC development that result in gastrointestinal motility disorders.

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Severe Idiopathic Constipation Is Associated With a Distinctive Abnormality of the Colonic Myenteric Plexus

Cited by 277 publications

References 23 publications

Is Anorectal Myectomy useful for Hirschsprung’s Disease and its Allied Disorders?

Is Anorectal Myectomy useful for Hirschsprung’s Disease and its Allied Disorders?

Surgical Management of Constipation

Therapy-refractory gastrointestinal motility disorder in a child with c-kit mutations

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