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

Area of Science:

• Gastroenterology
• Neurogastroenterology
• Pathophysiology

Background:

• Functional gastrointestinal disorders are increasingly linked to organic abnormalities, challenging previous psychosomatic models.
• Irritable bowel syndrome and functional dyspepsia show evidence of inflammation and immune activation.
• Esophageal achalasia involves abnormal neurotransmission and myenteric plexitis.

Discussion:

• Chronic constipation exhibits alterations in the enteric nervous system, including reduced enteric glial cells and interstitial cells of Cajal.
• These findings suggest a neuropathic basis for certain forms of chronic constipation.
• The traditional classification of chronic constipation as a functional disorder requires re-evaluation.

Key Insights:

• Chronic constipation is associated with a decrease in enteric glial cells and interstitial cells of Cajal.
• Evidence points towards an enteric neuropathic abnormality as a cause for chronic constipation.
• This challenges the long-held view of chronic constipation as a purely functional disorder.

Outlook:

• Reclassifying chronic constipation as an enteric neuropathic condition may lead to new diagnostic and therapeutic strategies.
• Further research into the specific mechanisms of enteric nervous system dysfunction in constipation is warranted.
• Understanding the organic basis of functional gastrointestinal disorders will improve patient outcomes.