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Intractable constipation with a decrease in substance P-immunoreactive fibres: is it a variant of intestinal neuronal

J M Hutson1, C W Chow, J Borg

  • 1F. Douglas Stephens Surgical Research Unit, Royal Children's Hospital, Melbourne, Australia.

Journal of Pediatric Surgery
|April 1, 1996
PubMed
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This study investigated nerve fiber changes in children with severe constipation, finding reduced substance P and vasoactive intestinal peptide in many cases. These findings may help identify treatable variants of intestinal neuronal dysplasia.

Area of Science:

  • Gastroenterology
  • Neuroscience
  • Pediatric Surgery

Background:

  • Severe chronic constipation in children can be challenging to diagnose, especially after ruling out Hirschsprung's disease.
  • Understanding the neurochemical basis of intestinal motility is crucial for diagnosing and treating functional bowel disorders.

Purpose of the Study:

  • To investigate the distribution of substance P (SP) and vasoactive intestinal peptide (VIP) immunoreactivity in the intestinal walls of children with severe chronic constipation.
  • To explore the potential of using neuropeptide analysis in seromuscular biopsies to identify new variants of intestinal neuronal dysplasia.

Main Methods:

  • Immunofluorescence was used to study SP and VIP immunoreactivity in seromuscular biopsies from the caecum, transverse colon, and sigmoid colon of 10 pediatric patients.

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  • Biopsies were obtained via laparoscopy and laparotomy.
  • Cases were analyzed for reductions or increases in SP- and VIP-immunoreactive nerve fibers, and one case of multiple endocrine neoplasia type 2b was noted for myenteric plexus hyperplasia.

    • Main Results:

    • Marked reductions in SP-immunoreactive fibers were observed in 7 out of 10 patients, with a concomitant reduction in VIP-immunoreactive fibers in 4 patients.
    • Two patients showed no significant reduction in SP or VIP fibers.
    • One patient with multiple endocrine neoplasia type 2b exhibited myenteric plexus hyperplasia with increased VIP and decreased SP fibers.

    Conclusions:

    • Seromuscular biopsies combined with immunofluorescence for neuropeptides can identify potential new variants of intestinal neuronal dysplasia.
    • Surgical interventions, such as subtotal colectomy, showed short-term improvement in some patients.
    • This approach may lead to successful surgical treatments for previously undiagnosed conditions causing severe constipation.