Cellular and molecular basis of chronic constipation: Taking the functional/idiopathic label out

作     者：Gabrio Bassotti Vincenzo Villanacci Dragos Cretoiu Sanda Maria Cretoiu Gabriel Becheanu 

作者机构：Gastroenterology and Hepatology Section Department of Clinical and Experimental Medicine University of Perugia Second Pathology SectionSpedali Civili Division of Cellular and Molecular Medicine Department of Morphological Sciences "Carol Davila" University of Medicine and Pharmacy Department of Molecular Medicine "Victor Babes" National Institute of Pathology Department of Ultrastructural Pathology "Victor Babes" National Institute of Pathology Department of Gastroenterology and Hepatology Fundeni Clinical Institute 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2013年第19卷第26期

页      面：4099-4105页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Constipation Enteric glia Enteric nervous system Enteric neurons Interstitial cells of Cajap Neurogastroenterology 

摘      要：In recent years, the improvement of technology and the increase in knowledge have shifted several strongly held paradigms. This is particularly true in gastroenterology, and specifically in the field of the so-called functional or idiopathic disease, where conditions thought for decades to be based mainly on alterations of visceral perception or aberrant psychosomatic mechanisms have, in fact, be reconducted to an organic basis (or, at the very least, have shown one or more demonstrable abnormalities). This is particularly true, for instance, for irritable bowel syndrome, the prototype entity of functional gastrointestinal disorders, where low-grade inflammation of both mucosa and myenteric plexus has been repeatedly demonstrated. Thus, researchers have also investigated other functional/idiopathic gastrointestinal disorders, and found that some organic ground is present, such as abnormal neurotransmission and myenteric plexitis in esophageal achalasia and mucosal immune activation and mild eosinophilia in functional dyspepsia. Here we show evidence, based on our own and other authors work, that chronic constipation has several abnormalities reconductable to alterations in the enteric nervous system, abnormalities mainly characterized by a constant decrease of enteric glial cells and interstitial cells of Cajal (and, sometimes, of enteric neurons). Thus, we feel that (at least some forms of) chronic constipation should no more be considered as a functional/idiopathic gastrointestinal disorder, but instead as a true enteric neuropathic abnormality.