Altered serotonin immunoreactivities in the left colon of patients with colonic inertia

Abstract

BACKGROUND: Serotonin is an important positive regulator of colonic motility and transit. Its quantity and distribution in the left colon could be abnormal in patients with colonic inertia (CI) and contribute to the disease. AIM: To evaluate serotonin positive cells and immuno-reactivities in the mucosa, submucosa and muscularis propria of the left colon from patients with CI was compared to a control group. PATIENTS AND METHODS: Nineteen patients who underwent subtotal colecotomy for CI were assessed. The control group consisted of 15 patients who underwent left hemicolectomy for colonic cancer; histologically normal tissue specimens were used. Immunohistochemical staining for serotonin was performed. In the mucosa, the average number of serotonin positive cells per microscopic field (200 x ) was determined. The positively stained area (square pixels) in the mucosa, submucosa and muscularis propria per microscopic field (200 x ) was calculated utilizing a computer image analysis program. RESULTS: In the mucosa, both the number of serotonin positive cells and positively stained area were significantly higher in the patient group than in controls (P < 0.05). The difference in serotonin positive area in the submucosa in the CI group compared to the control group was not statistically significant. There was a very significant correlation between the serotonin positive area in the submucosa and muscularis propria in controls (r=0.65, p < 0.01), but not in patients with CI. CONCLUSION: The increased serotonin level in patients with CI may contribute to the disease or be an adaptive response to some other pathology. The lack of a positive correlation in serotonin levels between the submucosa and muscularis propria in CI patients suggests that the coordinated distribution of serotonin may be disrupted in CI.

Surgical Outcomes after Total Colectomy with Ileorectal Anastomosis in Patients with Medically Intractable Slow Transit Constipation

“…Pathologic examinations of surgically-treated severe slow transit constipation patients have consistently revealed a decrease in neurons or neurofilaments [12, 13], and this abnormality is considered to be related to a decrease in the interstitial cell of Cajal (ICC), which is recognized as an intestinal pacemaker [10]. One report insisted that an increase and a decrease in neuropeptides, such as nitric oxide synthase, vasoactive intestinal peptide (VIP) and substance P, had a correlation with bowel movement, and another said that enterochromaffin cells and serotonin secreting cells were abnormally reduced in constipation patients [14, 15]. These results are similar to the findinga of this study in that the ganglion cell number was lower in 31 of the 37 patients.…”

The role of glial cells and apoptosis of enteric neurones in the neuropathology of intractable slow transit constipation

“…The number of apoptotic enteric neurones (fig 3C, D) was significantly increased in the myenteric plexus of STC patients (18 (15-20) v 11 (7)(8)(9)(10)(11)(12)(13)(14) cells; p = 0.0052) whereas no differences were found in the submucosal plexus (16 (12-19) v 12 (9-15) cells; p = 0.15).…”

“…7 8 Several qualitative and quantitative changes in the enteric nervous system of such patients have been described. They include abnormal enteric neurochemistry, [9][10][11][12] decreased argyrophilic neurones, 13 decreased intraganglionic neurofilaments, 14 and hypoganglionosis of the myenteric plexus. 15 More recently, a decrease in colonic interstitial cells of Cajal (ICC) in STC patients has also been reported.…”

Enteric neuropathology of the terminal ileum in patients with intractable slow-transit constipation

“…These include abnormal enteric neurochemistry [6,7], decreased argyrophilic neurons [8], decreased intraganglionic neurofilaments [9], hypoganglionosis of the myenteric plexus [10], and a decrease in colonic interstitial cells of Cajal (ICC) [11][12][13]. More recently, we have shown that patients with STC requiring surgery for intractable constipation, in addition to decreased ICC and enteric glial cells, have increased apoptotic phenomena of the enteric neurons [14].…”