Smooth muscle inclusion bodies in slow transit constipation

Slow transit constipation (STC) is a disorder of intestinal motility of unk nown aetiology. Myopathies, including those characterized by the finding of inclusion bodies, have been described in enteric disorders. Amphophilic in clusion bodies have been reported in the muscularis externa of the colon of STC patients. This study formally tested the hypothesis that these represe nt a primary muscle disorder, specific to STC. In a systematic, blinded, du al observer qualitative and quantitative analysis, colonic and ileal tissue from patients with STC (n = 36) were compared with selected control popula tions: total colonic aganglionosis (n = 10), Chagas' disease (n = 6), isola ted rectal evacuation disorders (n = 6), and a control population of a rang e of ages (n = 80). All sections were stained with haematoxylin and eosin a nd periodic acid Schiff. Further immunostains were used in an attempt to de termine inclusion body composition. Round or ovoid (j-22 pm diameter) ampho philic inclusions increased in number in normal subjects with age. Inclusio ns n:ere more frequent in idiopathic STC than in age-matched controls or re ctal evacuation disorders [ileum (33% vs. 9%), ascending (50% vs. 19%, p < 0.05), and sigmoid colon (43% vs. 20%)] and were very frequent in the sigmo id (71%) of patients with STC arising after pelvic surgery, The number of i nclusions per unit area was significantly higher in patients with STC (p < 0.001). Inclusions were found in all Chagas' patients, but not with agangli onosis. it was not possible to determine inclusion body composition, despit e the use of a wide range of conventional and immunostains, This study demo nstrates that inclusion body myopathy is identifiable in patients with STC and that it may arise secondary to denervation. Copyright (C) 2000 John Wil ey & Sons, Ltd.