Diseases of the Colon & Rectum

, Volume 36, Issue 12, pp 1112–1117 | Cite as

Visceral neuropathy in slow transit constipation: An immunohistochemical investigation with monoclonal antibodies against neurofilament

  • Willem R. Schouten
  • Fibo J. W. ten Kate
  • Eelco J. R. de Graaf
  • Ericus C. A. M. Gilberts
  • Jaap L. Simons
  • Paul Klück
Original Contributions
  • 34 Downloads

Abstract

PURPOSE: The aim of this study was to investigate neuropathologic changes in the colonic wall of patients with slow transit constipation using monoclonal antibodies raised against neurofilament. METHODS: In a prospective study, 227 patients with severe, long-standing constipation and intractable defecation disorders were analyzed according to a standard protocol. Slow transit constipation was diagnosed in 65 patients (29 percent). Fortythree patients (7 men and 36 women; mean age, 46 years; range, 16–76 years) underwent a partial (n=20) or subtotal (n=23) colectomy. In 39 patients (5 with megacolon and 34 with normal-sized colon) the cause of their constipation remained unexplained (idiopathic slow transit constipation). All resected colon specimens were investigated with the monoclonal antineurofilament antibody NF2F11 and compared with those of 20 control patients. RESULTS: In all controls the myenteric plexus revealed a moderate and diffuse axonal staining. In 29 of 39 patients with “idiopathic” slow transit constipation, the apparently normal axon bundles in the myenteric plexus stained markedly less than normal or failed to stain at all with the monoclonal antibody. In 17 patients this reduced or absent neurofilament expression was found along the entire length of the colon, whereas in 12 patients only a portion of the colon was affected. CONCLUSION: These findings indicate that a visceral neuropathy seems to be present in the majority of patients with severe, so-called idiopathic slow transit constipation.

Key words

Slow transit constipation Neurofilament Immunohistochemical investigation 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Martelli H, Devroede G, Arhan P, Duguay C, Domic C, Faverdin C. Some parameters of large bowel motility in normal man. Gastroenterology 1978;75:612–8.PubMedGoogle Scholar
  2. 2.
    Bueno L, Fioramonti J, Frexinos J, Ruckebush Y. Colonic myoelectrical activity in diarrhoea and constipation. Hepatogastroenterology 1980;27:381–9.PubMedGoogle Scholar
  3. 3.
    Shang JC, Devroede G, Duguay C, Hermond M, Hebert M. Constipation par inertie colique et obstruction terminale: etude electromyographique. Gastroenterol Clin Biol 1985;9:480–5.PubMedGoogle Scholar
  4. 4.
    Preston DM, Lennard-Jones JE. Pelvic colon motility and response to intraluminal bisacodyl in slow transit constipation. Dig Dis Sci 1985;30:289–94.PubMedGoogle Scholar
  5. 5.
    Shouler P, Keighley MR. Changes in colorectal function in severe chronic constipation. Gastroenterology 1986;90:414–20.PubMedGoogle Scholar
  6. 6.
    Smith B. Effect of irritant purgatives on the myenteric plexus in man and the mouse. Gut 1968;9:139–43.PubMedGoogle Scholar
  7. 7.
    Dyer NH, Dawson AM, Smith BF, Todd IP. Obstruction of bowel due to lesion in the myenteric plexus. BMJ 1969;1:686–9.PubMedGoogle Scholar
  8. 8.
    Preston DM, Butler MG, Smith B, Lennard-Jones JE. Neuropahtology of slow transit constipation. Gut 1983;24:A997.Google Scholar
  9. 9.
    Krishnamurthy S, Schuffler MD, Rohrmann CA, Pope CE. Severe idiopathic constipation is associated with a distinctive abnormality of the colonicmyenteric plexus. Gastroenterology 1985;88:26–34.PubMedGoogle Scholar
  10. 10.
    Sninsky CA, Davis RH, Clench MH,et al. Severe idiopathic intestinal constipation: comparison of histology and gastrointestinal tracing in human subjects. Gastroenterology 1984;86:A1259.Google Scholar
  11. 11.
    Koch TR, Carney JA, Go L, Go VL. Idiopathic chronic constipation is associated with decreased colonic vasoactive intestinal peptide. Gastroenterology 1988;94:300–10.PubMedGoogle Scholar
  12. 12.
    Goldin E, Karmeli F, Selinger Z, Rachmilenitz D. Colonic substance P levels are increased in ulcerative colitis and decreased in chronic constipation. Dig Dis Sci 1989;34:754–7.PubMedGoogle Scholar
  13. 13.
    Milner P, Crowe R, Kamm MA, Lennard-Jones JE, Burnstock G. Vasoactive intestinal polypeptide levels in sigmoid colon in idiopathic constipation and diverticular disease. Gastroenterology 1990;99:666–75.PubMedGoogle Scholar
  14. 14.
    Burleigh DE. Evidence for a functional cholinergic deficit in human colonic-tissue resected for constipation. J Pharmacol 1988;40:55–7.Google Scholar
  15. 15.
    Waldron D, Bowes KL, Kingma YJ, Cote RR. Colonic and anorectal motility in young women with severe idiopathic constipation. Gastroenterology 1988;95:1388–94.PubMedGoogle Scholar
  16. 16.
    Roe AM, Bartolo DC, Mortensen NJ. Slow transit constipation. Comparison between patients with or without previous hysterectomy. Dig Dis Sci 1988;33:1159–63.PubMedGoogle Scholar
  17. 17.
    Lanfranchi GA, Bazzochi G, Brignola C, Campieri M, Labo G. Different patterns of intestinal transit time and anorectal manometry in painful and painless chronic constipation. Gut 1984;25:1325–7.Google Scholar
  18. 18.
    Muijen GN, Ruiter DJ, van Leeuwen C, Prins FA, Rietsema K, Warnaar SO. Cytokeratin and neurofilament in lung carcinomas. Am J Pathol 1984;116:363–9.PubMedGoogle Scholar
  19. 19.
    Luider TM, van Dommelen MW, Tibboel D,et al. Differences in phosphorylation state of neurofilament proteins in ganglionic and aganglionic bowel segments of children with Hirschsprung's disease. J Pediatr Surg 1992;27:815–9.PubMedGoogle Scholar
  20. 20.
    Klück P, Muijen GN, van der Kamp AW,et al. Hirschsprung's disease studied with monoclonal antineurofilament antibodies on tissue sections. Lancet 1984;1:652–3.PubMedGoogle Scholar
  21. 21.
    Preston DM, Lennard-Jones JE. Severe chronic constipation of young women: idiopathic STC. Gut 1986;27:41–8.PubMedGoogle Scholar
  22. 22.
    Preston DM, Rees IH, Lennard-Jones JE. Gynaecological disorders and hyperprolactinaemia in chronic constipation. Gut 1983;24:A480.Google Scholar
  23. 23.
    Watier A, Devroede G, Duvanceau A,et al. Constipation with colonic inertia. A manifestation of systemic disease. Dig Dis Sci 1983;28:1025–33.PubMedGoogle Scholar
  24. 24.
    Varma IS, Smith AN. Neurophysiological dysfunction in young women with intractable constipation. Gut 1988;29:963–8.PubMedGoogle Scholar
  25. 25.
    Lazarides E. Intermediate filaments: a chemically heterogeneous, developmentally regulated class of proteins. Annu Rev Biochem 1982;51:219–50.PubMedGoogle Scholar
  26. 26.
    Bradford HF. Chemical neurobiology. 1st ed. New York: WH Freeman, 1986.Google Scholar
  27. 27.
    Eaker EY, Shaw G, Sninsky CA. Neurofilament immunoreactivity in myenteric neurons differs from that found in the central nervous system. Gastroenterology 1990;99:1364–71.PubMedGoogle Scholar
  28. 28.
    Gambetti P, Autilio-Gambetti L, Papasozomenos SC. Bodian's silver method stains neurofilament polypeptides. Science 1981;213:1521–2.PubMedGoogle Scholar
  29. 29.
    Smith B. The myenteric plexus in drug-induced neuropathy. J Neurol Neurosurg Psychiatr 1968;30:506–10.Google Scholar
  30. 30.
    Krishnamurthy S, Schuffler MD. Pathology of neuromuscular disorders of the small intestine and colon. Gastroenterology 1987;93:610–39.PubMedGoogle Scholar
  31. 31.
    Gold B, Price DL, Griffin JW. Neurofilament antigens in acrylamide neuropathy. Neuropathol Exp Neurol 1988;47:145–57.Google Scholar
  32. 32.
    Ferri GL, Zareh S, Amadoni A. 2.5 Hexanedione induced accumulations of neurofilament-immunoreactive material throughout the rat autonomic nervous system. Brain Res 1988;444:383–8.PubMedGoogle Scholar
  33. 33.
    Donaghy M, King RH, Thomas PK, Workman JM. Abnormalities of the axonal cytoskeleton in giant axonal neuropathy. J Neuropathol 1988;17:197–208.Google Scholar
  34. 34.
    Munoz DG, Greene C, Perl DP, Selkoe DJ. Accumulation of phospholyrated neurofilaments in anterior horn motoneurons of amyotrophic lateral sclerosis patients. J Neuropathol Exp Neurol 1988;47:9–18.PubMedGoogle Scholar
  35. 35.
    Smith B. Pathologic changes in the colon produced by anthraquinone purgatives. Dis Colon Rectum 1973;16:455–8.PubMedGoogle Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1993

Authors and Affiliations

  • Willem R. Schouten
    • 1
  • Fibo J. W. ten Kate
    • 2
  • Eelco J. R. de Graaf
    • 1
  • Ericus C. A. M. Gilberts
    • 1
  • Jaap L. Simons
    • 1
  • Paul Klück
    • 2
  1. 1.Department of SurgeryUniversity Hospital DijkzigtRotterdamThe Netherlands
  2. 2.Department of PathologyUniversity Hospital DijkzigtRotterdamThe Netherlands

Personalised recommendations