Dysplasia of the submucous nerve plexus in slow-transit constipation of adults

Aim A clinicopathological entity, intestinal neuronal dysplasia type B (IND ) has been described in children with severe constipation. The present stud y was designed to evaluate whether IND could be identified in adult patient s with idiopathic slow-transit constipation. Methods Rectal biopsies were taken from 27 constipated patients with docume nted slow colonic transit and 23 controls and stained for S100 protein, ace tylcholine esterase and lactate dehydrogenase. The mean and maximal number of ganglion cells per ganglion, mean number of ganglia and mean number of g anglion cells per mm(2) of submucosal tissue, mean and maximal diameter of ganglion cells, maximal thickness of submucosal nerve fibres, and number of S100-positive cells per mm2 mucosal tissue were quantified. The density of submucosal ganglia, presence of heterotopic ganglion cells, intensity of s taining of the adventitial layer of submucosal arteries, and density of ner ve fibres in submucosa and lamina propria were evaluated qualitatively. In addition, subjective evaluation by an experienced pathologist was performed . Results There were no major differences between patients and controls, exce pt that patients had slightly thicker submucosal nerves than controls (30.8 +/- 1.6 versus 25.5 +/- 2.0 pm, P < 0.05) and more frequent heterotopic ga nglion cells (32 versus 6%, P < 0.05). Neither discriminant analysis of the morphometric data nor subjective evaluation was able to correctly classify the slides as originating from patients or controls. Conclusions The existence of the clinicopathological entity IND in adults w ith slow-transit constipation is unlikely. For further classification of sl ow-transit constipation, rectal biopsies do not appear to be useful at pres ent, Eur J Gastroenterol Hepatol 12:755-759 (C) 2000 Lippincott Williams & Wilkins.