Distinct enteric nervous system pattern in obstructed defecation syndrome and slow-transit constipation: a controlled...

Area of Science:

• Gastroenterology
• Neurogastroenterology
• Digital Pathology

Background:

• Chronic constipation is heterogeneous, encompassing slow-transit constipation (STC) and obstructed defecation syndrome (ODS).
• Neuroenteric mechanisms are implicated, but histomorphological correlates are not well-defined due to methodological heterogeneity.
• Standardized quantification of myenteric plexus morphology and neuroimmune cells is needed.

Purpose of the Study:

• To characterize myenteric plexus morphology and neuroimmune cell distribution in clinically defined subgroups of functional bowel disorders.
• To utilize a standardized digital pathology approach for reproducible quantification.
• To identify distinct histomorphological patterns associated with ODS and STC.

Main Methods:

• Retrospective observational cohort study of 100 patients (ODS, STC, combined ODS+STC, controls).
• Digital morphometric assessment of ganglionic density, morphology, and neuronal content (MAP2, HuC/D).
• Analysis of CD3-positive T-lymphocyte distribution within and around myenteric ganglia.

Main Results:

• Significant differences in ganglionic density between groups (p=0.002), with increased density in ODS.
• Neuronal content per ganglion was preserved across all groups.
• Reduced CD3-positive T-lymphocytes observed in all constipation groups, most pronounced in STC.

Conclusions:

• Functional bowel disorders exhibit distinct neuroarchitectural and neuroimmune patterns.
• ODS shows increased ganglionic density, while STC has reduced T-lymphocytes and preserved neuronal content.
• Standardized digital morphometry provides a reproducible framework for characterizing chronic constipation phenotypes.