Histological changes in the colon wall in adult patients with chronic slow-transit constipation





chronic slow‑transit constipation, myopathic changes, neuropathic changes, Cajal cell pathology


The prevalence of chronic constipation in the population ranges from 3% to 27%. Women, senile people, and people of low socio‑economic status are in this risk group more often. Many histological studies of the intestinal wall were performed in order to find the causes of slow‑transit constipation [6, 4]. The different pathological changes, including myopathies, neuropathy, and pathology of the interstitial cells of Cajal, were established. The specific distribution of the types of histological changes in the colon wall in patients with slow‑transit constipation, as presented in the London classification, is currently unknown.

Objective — to determine the specific distribution of the types of histological changes in the colon wall in patients with slow‑transit constipation unresponsive to conservative treatment.

Materials and methods. A pathomorphological comparative case‑control study was performed. The main group included 105 patients who underwent colectomy as a treatment for chronic slow‑transit constipation in the period 2011—2023. The surgical intervention was indicated for patients with chronic slow‑transit constipation, resistance to conservative treatment, and a notable decline in quality of life. The comparison group included 27 deceased persons who did not experience constipation during their lifetime. The patient exclusion criteria were Hirschsprung’s disease, proctogenic constipation (dysfunction of the rectum and pelvic floor), medication‑associated constipation, as well as mental disorders. The histological and immunological examinations of samples were carried out in both groups, in the comparison group — appendix, ileum, cecum, colon and sigmoid colon.

Results. Four main morphological phenotypes of the colon wall structure elements in patients with chronic slow‑transit constipation were identified according to the research data: 1) histologically intact type, 2) myopathic type, 3) Cajal type, 4) neuropathic. A combination of different types of histological changes was also registered, but one of them usually dominated.

Conclusions. Four main types of histological changes in the intestinal wall were found in patients with chronic slow‑transit constipation resistant to conservative treatment: myopathic changes (56.2%), Cajal cell pathology (19%), neuropathic changes (19%), and a histologically intact variant (5.8%). The myopathic type is characterised by the heterogeneity of morphological manifestations, which can be referred to as dystrophic changes (dystrophic subtype 79.7%) and inflammatory changes (inflammatory subtype 20.3%), p=0.001.



Andresen V, Becker G, Frieling T, Goebel-Stengel M, Gundling F, Herold A, Karaus M, Keller J, Kim M, Klose P, Krammer H, Kreis ME, Kuhlbusch-Zicklam R, Langhorst J, Layer P, Lenzen-Großimlinghaus R, Madisch A, Mönnikes H, Müller-Lissner S, Rubin D, Schemann M, Schwille-Kiuntke J, Stengel A, Storr M, van der Voort I, Voderholzer W, Wedel T, Wirz S, Witzigmann H, Pehl C; In Zusammenarbeit mit:; Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV)/Chirurgische Arbeitsgemeinschaft für Coloproktologie (CACP); Deutsche Gesellschaft für Ernährungsmedizin (DGEM), Deutsche Gesellschaft für Naturheilkunde (DGNHK); Deutsche Gesellschaft für Geriatrie (DGG); Deutsche Gesellschaft für Koloproktologie (DGK); Deutsche Gesellschaft für Innere Medizin (DGIM); Deutsche Gesellschaft für Palliativmedizin e. V. (DGP); Deutsche Schmerzgesellschaft e. V., MAGDA Patientenforum (MAGDA). Aktualisierte S2k-Leitlinie chronische Obstipation der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie & Motilität (DGNM) — April 2022 — AWMF-Registriernummer: 021-019. Z Gastroenterol. 2022 Oct;60(10):1528-1572. German. http://doi.org/10.1055/a-1880-1928. Epub 2022 Oct 12. PMID: 36223785.

Camilleri M, Ford AC, Mawe GM, Dinning PG, Rao SS, Chey WD, Simrén M, Lembo A, Young-Fadok TM, Chang L. Chronic constipation. Nat Rev Dis Primers. 2017 Dec 14;3:17095. http://doi.org/10.1038/nrdp.2017.95. PMID: 29239347.

Du X, Liu S, Jia P, Wang X, Gan J, Hu W, Zhu H, Song Y, Niu J, Ji Y. Epidemiology of Constipation in Elderly People in Parts of China: A Multicenter Study. Front Public Health. 2022 Jun 15;10:823987. http://doi.org/10.3389/fpubh.2022.823987. PMID: 35784241; PMCID: PMC9240593.

Friedmacher F, Rolle U. Interstitial cells of Cajal: clinical relevance in pediatric gastrointestinal motility disorders. Pediatr Surg Int. 2023 Apr 27;39(1):188. http://doi.org/10.1007/s00383-023-05467-1. PMID: 37101012; PMCID: PMC10133055.

Gonçalves AC, de Faria Oliveira IS, Hamamoto Filho PT, Ortolan EVP, Terra SA, Rodrigues MAM, de Arruda Lourenção PLT. Association between Clinical and Histopathological Findings in Intestinal Neuronal Dysplasia Type B: An Advance towards Its Definition as a Disease. Life (Basel). 2023 May 12;13(5):1175. http://doi.org/10.3390/life13051175. PMID: 37240820; PMCID: PMC10221867.

He CL, Burgart L, Wang L, Pemberton J, Young-Fadok T, Szurszewski J, Farrugia G. Decreased interstitial cell of cajal volume in patients with slow-transit constipation. Gastroenterology. 2000 Jan;118(1):14-21. http://doi.org/10.1016/s0016-5085(00)70409-4. PMID: 10611149.

Knowles CH, De Giorgio R, Kapur RP, Bruder E, Farrugia G, Geboes K, Lindberg G, Martin JE, Meier-Ruge WA, Milla PJ, Smith VV, Vandervinden JM, Veress B, Wedel T. The London Classification of gastrointestinal neuromuscular pathology: report on behalf of the Gastro 2009 International Working Group. Gut. 2010 Jul;59(7):882-7. http://doi.org/10.1136/gut.2009.200444. PMID: 20581236.

Otani K, Watanabe T, Takahashi K, Nadatani Y, Fukunaga S, Hosomi S, Tanaka F, Kamata N, Taira K, Nagami Y, Kimura T, Fukumoto S, Kawada N, Fujiwara Y. Prevalence and risk factors of functional constipation in the Rome IV criteria during a medical check-up in Japan. J Gastroenterol Hepatol. 2021 Aug;36(8):2157-2164. http://doi.org/10.1111/jgh.15436. Epub 2021 Feb 15. PMID: 33555082.

Schuffler MD, Jonak Z. Chronic idiopathic intestinal pseudo-obstruction caused by a degenerative disorder of the myenteric plexus: the use of Smith’s method to define the neuropathology. Gastroenterology. 1982 Mar;82(3):476-86. PMID: 6172315.

Serra J, Pohl D, Azpiroz F, Chiarioni G, Ducrotté P, Gourcerol G, Hungin APS, Layer P, Mendive JM, Pfeifer J, Rogler G, Scott SM, Simrén M, Whorwell P; Functional Constipation Guidelines Working Group. European society of neurogastroenterology and motility guidelines on functional constipation in adults. Neurogastroenterol Motil. 2020 Feb;32(2):e13762. http://doi.org/10.1111/nmo.13762. Epub 2019 Nov 22. PMID: 31756783.

Suares NC, Ford AC. Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta-analysis. Am J Gastroenterol. 2011 Sep;106(9):1582-91; quiz 1581, 1592. http://doi.org/10.1038/ajg.2011.164. Epub 2011 May 24. PMID: 21606976.

Vitton V, Damon H, Benezech A, Bouchard D, Brardjanian S, Brochard C, Coffin B, Fathallah N, Higuero T, Jouët P, Leroi AM, Luciano L, Meurette G, Piche T, Ropert A, Sabate JM, Siproudhis L; SNFCP CONSTI Study Group. Clinical practice guidelines from the French National Society of Coloproctology in treating chronic constipation. Eur J Gastroenterol Hepatol. 2018 Apr;30(4):357-363. http://doi.org/10.1097/MEG.0000000000001080. PMID: 29406436.






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