THE NEUROMUSCULAR COMPARTMENT IN INTESTINAL DYSMOTILITY: STATE OF THE ART

The disorders of gastrointestinal motility comprise a heterogeneous group of chronic conditions, which are considered to be relevant for public health, since they are very common, can be disabling, and induce major social and economic burdens. Abnormal bowel motility is associated with a wide range of diseases, differing for etiopathogenic mechanisms, pathologic lesions, and region of gut involvement (e.g., irritable bowel syndrome, slow transit constipation, inflammatory bowel disease, diverticular disease). These motor disturbances are suggestive of alterations of enteric neuromuscular cellular components, including cells of the enteric nervous system (i.e. myenteric neurons, glial cells, interstitial cells of Cajal), and circular and longitudinal smooth muscle cells. Although the presence of intestinal dysmotility in patients with the above gut disorders has been well established in the clinical setting, scarce attention has been paid to the respective morphological arrangements of enteric cellular networks in the neuromuscular compartment of gut wall. In this regard, previous attempts, made to obtain reliable quantitative estimations of enteric cells involved in gut motility, yielded hardly comparable, or even conflicting, results. Thus, in order to overcome the lack or heterogeneity of current data, careful morphological examinations and development of standardized procedures are particularly required in the field of gastrointestinal neuromuscular pathology, as recently suggested (Knowles et al., Acta Neuropathol 2009; Knowles et al., Gut 2010).