Advertisement

Techniques in Coloproctology

, Volume 15, Issue 4, pp 371–375 | Cite as

Beyond hematoxylin and eosin: the importance of immunohistochemical techniques for evaluating surgically resected constipated patients

  • G. BassottiEmail author
  • V. Villanacci
  • B. Salerni
  • C. A. Maurer
  • G. Cathomas
Review

Abstract

Chronic constipation requiring surgical ablation for intractability is often a frustrating condition from the pathologist’s point of view. In fact, limiting the histological examination to only hematoxylin–eosin staining usually yields only the information that there are no abnormalities. By employing some simple and widely available immunohistochemical methods, discussed in this review, it is possible to gather data that may help in explaining the pathophysiological basis of constipation in these patients.

Keywords

Constipation Histology Immunohistochemistry Surgery 

References

  1. 1.
    Pare P, Ferrazzi S, Thompson WG, Irvine EJ, Rance L (2001) An epidemiological survey of constipation in Canada: definitions, rates, demographics, and predictors of health care seeking. Am J Gastroenterol 96:3130–3137PubMedCrossRefGoogle Scholar
  2. 2.
    Rao SS (2009) Constipation: evaluation and treatment of colonic and anorectal motility disorders. Gastrointest Endosc Clin N Am 19:117–139PubMedCrossRefGoogle Scholar
  3. 3.
    Iantorno G, Cinquetti M, Mazzocchi A, Morelli A, Bassotti G (2007) Audit of constipation in a gastroenterology referral center. Dig Dis Sci 52:317–320PubMedCrossRefGoogle Scholar
  4. 4.
    Tack J, Müller-Lissner S (2009) Treatment of chronic constipation: current pharmacologic approaches and future directions. Clin Gastroenterol Hepatol 7:502–508PubMedCrossRefGoogle Scholar
  5. 5.
    Khaikin M, Wexner SD (2006) Treatment strategies in obstructed defecation and fecal incontinence. World J Gastroenterol 12:3168–3173PubMedGoogle Scholar
  6. 6.
    Velio P, Bassotti G (1996) Chronic idiopathic constipation: pathophysiology and treatment. J Clin Gastroenterol 22:190–196PubMedCrossRefGoogle Scholar
  7. 7.
    Bassotti G, de Roberto G, Sediari L, Morelli A (2004) Colonic motility studies in severe chronic constipation: an organic approach to a functional problem. Tech Coloproctol 8:147–150PubMedCrossRefGoogle Scholar
  8. 8.
    Dinning PG, Benninga MA, Southwell BR, Scott SM (2010) Paediatric and adult colonic manometry: a tool to help unravel the pathophysiology of constipation. World J Gastroenterol 16:5162–5172PubMedCrossRefGoogle Scholar
  9. 9.
    Bassotti G, Chiarioni G, Germani U, Battaglia E, Vantini I, Morelli A (1999) Endoluminal instillation of bisacodyl in patients with severe (slow transit type) constipation is useful to test residual colonic propulsive activity. Digestion 60:69–73PubMedCrossRefGoogle Scholar
  10. 10.
    Shafik A, Shafik AA, El-Sibai O, Mostafa RM (2003) Electric activity of the colon in subjects with constipation due to total colonic inertia. An electrophysiologic study. Arch Surg 138:1007–1011PubMedCrossRefGoogle Scholar
  11. 11.
    Bassotti G, Roberto GD, Sediari L, Morelli A (2004) Toward a definition of colonic inertia. World J Gastroenterol 10:2465–2467PubMedGoogle Scholar
  12. 12.
    Frattini JC, Nogueras JJ (2008) Slow transit constipation: a review of a colonic functional disorder. Clin Colon Rectal Surg 21:146–152PubMedCrossRefGoogle Scholar
  13. 13.
    Levitt MA, Mathis KL, Pemberton JH (2011) Surgical treatment for constipation in children and adults. Best Pract Res Clin Gastroenterol 25:167–179PubMedCrossRefGoogle Scholar
  14. 14.
    Riss S, Herbst F, Birsan T, Stift A (2009) Postoperative course and long term follow up after colectomy for slow transit constipation–is surgery an appropriate approach? Colorectal Dis 11:302–307PubMedCrossRefGoogle Scholar
  15. 15.
    Martin JE, Hester TW, Aslam H, Sinha S, Knowles CH (2009) Discordant practice and limited histopathological assessment in gastrointestinal neuromuscular disease. Gut 58:1703–1705PubMedCrossRefGoogle Scholar
  16. 16.
    Koch T, Carney JA, Go VL (1988) Idiopathic chronic constipation is associated with decreased colonic vasoactive intestinal peptide. Gastroenterology 94:300–310PubMedGoogle Scholar
  17. 17.
    Zhao RH, Baig MK, Mack J, Abramson S, Woodhouse S, Wexner SD (2002) Altered serotonin immunoreactivities in the left colon of patients with colonic inertia. Colorectal Dis 4:56–60PubMedCrossRefGoogle Scholar
  18. 18.
    Krishnamurti S, Schuffler MD, Rohrmann CA, Pope CE (1985) Severe idiopathic constipation is associated with a distinctive abnormality of the colonic myenteric plexus. Gastroenterology 88:26–34Google Scholar
  19. 19.
    Schouten WR, ten Kate FJ, de Graaf EJ, Gilberts EC, Simons JL, Kluck P (1993) Visceral neuropathy in slow transit constipation: an immunohistochemical investigation with monoclonal antibodies against neurofilament. Dis Colon Rectum 36:1112–1117PubMedCrossRefGoogle Scholar
  20. 20.
    Wedel T, Roblick UJ, Ott V et al (2002) Oligoneural hypoganglionosis in patients with idiopathic slow transit constipation. Dis Colon Rectum 45:54–62PubMedCrossRefGoogle Scholar
  21. 21.
    Wedel T, Spiegler J, Soellner S et al (2002) Enteric nerves and interstitial cells of Cajal are altered in patients with slow transit constipation and megacolon. Gastroenterology 123:1459–1467PubMedCrossRefGoogle Scholar
  22. 22.
    Tong WD, Liu BH, Zhang LY, Zhang SB, Lei Y (2004) Decreased interstitial cells of Cajal in the sigmoid colon of patients with slow transit constipation. Int J Colorect Dis 19:467–473CrossRefGoogle Scholar
  23. 23.
    Bassotti G, Villanacci V, Maurer CA et al (2006) The role of glial cells and apoptosis of enteric neurones in the neuropathology of intractable slow transit constipation. Gut 55:41–46PubMedCrossRefGoogle Scholar
  24. 24.
    Bassotti G, Villanacci V, Nascimbeni R et al (2007) Colonic neuropathological aspects in patients with intractable constipation due to obstructed defecation. Mod Pathol 20:367–374PubMedCrossRefGoogle Scholar
  25. 25.
    Knowles CH, De Giorgio R, Kapur RP et al (2009) Gastrointestinal neuromuscular pathology: guidelines for histological techniques and reporting on behalf of the gastro 2009 international working group. Acta Neuropathol 118:271–301PubMedCrossRefGoogle Scholar
  26. 26.
    Hutson JM, Chow CW, Borg J (1996) Intractable constipation with a decrease in substance P-immunoreactive fibres: is it a variant of intestinal neuronal dysplasia? J Pediatr Surg 31:580–583PubMedCrossRefGoogle Scholar
  27. 27.
    King SK, Sutcliffe JR, Hutson JM (2005) Laparoscopic seromuscular colonic biopsies: a surgeon’s experience. J Pediatr Surg 40:381–384PubMedCrossRefGoogle Scholar
  28. 28.
    Ohlsson B, Fork FT, Veress B, Toth E (2005) Coexistent chronic idiopathic intestinal pseudo obstruction and inflammatory bowel disease. Gut 54:729–730PubMedCrossRefGoogle Scholar
  29. 29.
    Porter AJ, Wattchow DA, Brookes SJ, Costa M (1997) The neurochemical coding and projections of circular muscle motor neurons in the human colon. Gastroenterology 113:1916–1923PubMedCrossRefGoogle Scholar
  30. 30.
    Ganns D, Schrödl F, Neuhuber W, Brehmer A (2006) Investigation of general and cytoskeletal markers to estimate numbers and proportions of neurons in the human intestine. Histol Histopathol 21:41–51PubMedGoogle Scholar
  31. 31.
    Murphy EM, Defontgalland D, Costa M, Brookes SJ, Wattchow DA (2007) Quantification of subclasses of human colonic myenteric neurons by immunoreactivity to Hu, choline acetyltransferase and nitric oxide synthase. Neurogastroenterol Motil 19:126–134PubMedCrossRefGoogle Scholar
  32. 32.
    Krammer HJ, Karahan ST, Sigge W, Kühnel W (1994) Immunohistochemistry of markers of the enteric nervous system in whole-mount preparations of the human colon. Eur J Pediatr Surg 4:274–278PubMedCrossRefGoogle Scholar
  33. 33.
    Dzienis-Koronkiewicz E, Debek W, Sulkowska M, Chyczewski L (2002) Suitability of selected markers for identification of elements of the intestinal nervous system (INS). Eur J Pediatr Surg 12:397–401PubMedCrossRefGoogle Scholar
  34. 34.
    Villanacci V, Bassotti G, Ortensi B et al (2008) Expression of the Rai (Shc C) adaptor protein in the human enteric nervous system. Neurogastroenterol Motil 20:206–212PubMedCrossRefGoogle Scholar
  35. 35.
    Hoff S, Zeller F, von Weyhern CW et al (2008) Quantitative assessment of glial cells in the human and guinea pig enteric nervous system with an anti-Sox8/9/10 antibody. J Comp Neurol 509:356–371PubMedCrossRefGoogle Scholar
  36. 36.
    Williams DE, Eisenman J, Baird A et al (1990) Identification of a ligand for the c-kit proto-oncogene. Cell 63:167–174PubMedCrossRefGoogle Scholar
  37. 37.
    Horisawa M, Watanabe Y, Torihashi S (1998) Distribution of c-Kit immunopositive cells in normal human colon and in Hirschsprung’s disease. J Pediatr Surg 33:1209–1214PubMedCrossRefGoogle Scholar
  38. 38.
    Knowles CH, Silk DB, Darzi A et al (2004) Deranged smooth muscle alpha-actin as a biomarker of intestinal pseudo-obstruction: a controlled multinational case series. Gut 53:1583–1589PubMedCrossRefGoogle Scholar
  39. 39.
    Smith VV, Gregson N, Foggensteiner L, Neale G, Milla PJ (1997) Acquired intestinal aganglionosis and circulating autoantibodies without neoplasia or other neural involvement. Gastroenterology 112:1366–1371PubMedCrossRefGoogle Scholar
  40. 40.
    De Giorgio R, Barbara G, Stanghellini V et al (2002) Clinical and morphofunctional features of idiopathic myenteric ganglionitis underlying severe intestinal motor dysfunction: a study of three cases. Am J Gastroenterol 97:2454–2459PubMedCrossRefGoogle Scholar
  41. 41.
    Haas S, Bindl L, Fischer HP (2005) Autoimmune enteric leiomyositis: a rare cause of chronic intestinal pseudo-obstruction with specific morphological features. Hum Pathol 36:576–580PubMedCrossRefGoogle Scholar
  42. 42.
    Bassotti G, Villanacci V (2006) Slow transit constipation: a functional disorder becomes an enteric neuropathy. World J Gastroenterol 12:4609–4613PubMedGoogle Scholar
  43. 43.
    Bassotti G, Villanacci V, Antonelli E, Morelli A, Salerni B (2007) Enteric glial cells: new players in gastrointestinal motility? Lab Invest 87:628–632PubMedCrossRefGoogle Scholar
  44. 44.
    Bassotti G, Villanacci V (2011) Can “functional” constipation be considered as a form of enteric neuro-gliopathy? Glia 59:345–350PubMedCrossRefGoogle Scholar
  45. 45.
    Rossi E, Villanacci V, Fisogni S et al (2007) Chromosomal study of enteric glial cells and neurons by fluorescence in situ hybridization in slow transit constipation. Neurogastroenterol Motil 19:578–584PubMedCrossRefGoogle Scholar
  46. 46.
    Bassotti G, Villanacci V, Fisogni S et al (2007) Comparison of three methods to assess enteric neuronal apoptosis in patients with slow transit constipation. Apoptosis 12:329–332PubMedCrossRefGoogle Scholar
  47. 47.
    Bassotti G, Villanacci V, Fisogni S, Cadei M, Di Fabio F, Salerni B (2007) Apoptotic phenomena are not a major cause of enteric neuronal loss in constipated patients with dementia. Neuropathology 27:67–72PubMedCrossRefGoogle Scholar
  48. 48.
    Gibbons SJ, De Giorgio R, Pellegrini MS et al (2009) Apoptotic cell death of human interstitial cells of Cajal. Neurogastroenterol Motil 21:85–93PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • G. Bassotti
    • 1
    • 6
    Email author
  • V. Villanacci
    • 2
  • B. Salerni
    • 3
  • C. A. Maurer
    • 4
  • G. Cathomas
    • 5
  1. 1.Gastroenterology and Hepatology Section, Department of Clinical and Experimental MedicineUniversity of PerugiaPerugiaItaly
  2. 2.Second Pathology Section, Department of Laboratory DiagnosticsUniversity of BresciaBresciaItaly
  3. 3.2nd Surgical Chair, Department of Surgery, Spedali CiviliUniversity of BresciaBresciaItaly
  4. 4.Department of SurgeryLiestal HospitalLiestalSwitzerland
  5. 5.Cantonal Institute of PathologyLiestal HospitalLiestalSwitzerland
  6. 6.Clinica di Gastroenterologia ed EpatologiaOspedale Santa Maria della MisericordiaSan Sisto, PerugiaItaly

Personalised recommendations