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Rectal myopathy in chronically constipated children
R D Murray1, S J Qualman, P Powers
1Department of Pediatrics, Ohio State University, Children's Hospital, Columbus 43205.
Insights
Rectal biopsies revealed significant muscle atrophy in children with chronic constipation. These findings suggest potential causes including chronic distention and altered gut hormones.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Motility Disorders
- Rectal Muscular Histopathology
Background:
- Chronic constipation is a common pediatric issue with varied underlying mechanisms.
- Rectal muscle abnormalities may contribute to defecation difficulties in children.
- Understanding rectal myopathy is crucial for diagnosing and managing pediatric constipation.
Purpose of the Study:
- To investigate rectal muscle thickness and neural staining in children with chronic constipation.
- To compare rectal tissue characteristics between constipated children and controls.
- To identify histopathological changes associated with chronic constipation in pediatric patients.
Main Methods:
- Analysis of full-thickness rectal biopsies from 30 children with chronic constipation and controls.
- Evaluation of muscularis mucosae thickness, muscle layer dimensions, and their ratio.
- Assessment of vasoactive intestinal peptide (VIP) immunohistochemical staining intensity.
Main Results:
- All constipated children exhibited rectal musculature atrophy, including muscle fiber vacuolation or disappearance.
- Increased muscularis mucosae thickness (P < .01) and a decreased circular-to-longitudinal muscle ratio were observed.
- Progressive myopathic changes were noted in follow-up biopsies over 9 years.
Conclusions:
- Children with chronic constipation demonstrate significant rectal muscular atrophy.
- Potential etiologies include chronic distention, denervation, and functional obstruction.
- Histopathological rectal changes may offer insights into the pathophysiology of pediatric constipation.
Abstract:
We examined full-thickness rectal biopsies from 30 children who had chronic constipation, including 5 children with constipation associated with clinical symptoms of intestinal pseudo-obstruction. Biopsies from 9 patients who required colonic interposition and from 7 with Hirschsprung's disease were used as controls. Tissues were evaluated for muscularis mucosae thickness (in mm), for absolute circular and longitudinal muscle layer thicknesses and their ratio, and for the intensity of neural vasoactive intestinal peptide (VIP) immunohistochemical staining. Atrophy of the rectal musculature with focal muscle fiber vacuolation or muscle fiber disappearance was found in all children with chronic constipation. Muscularis mucosae thickness was increased (P < .01) and the circular-to-longitudinal muscle ratio was decreased in the constipation group, with the greatest degree of atrophy being demonstrated in the circular layer. Two of the patients had additional biopsies up to 9 years after the first that illustrate progressive myopathic changes over time. This study demonstrates muscular atrophy in the rectum of children with chronic constipation. Besides primary idiopathic disease, potential etiologies include chronic distention, denervation, functional obstruction from obstipation, alteration in gut hormones, and toxic, ischemic, or neural injury.