Neuro-muscular apparatus in human colon and in children with chronic constipation

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NIDKIDS is a support group for children with chronic constipation. There are 200 patients at the Royal Childrens Hospital in Melbourne who are in this group because their constipation has not responded to any treatments. Movement of food along the intestine requires muscle in the wall of the intestine to contract in a coordinated pattern. Coordination of the muscle contractions is provided by the nervous system. The nervous system controlling the gut has cell bodies located within the gut wall, that send processes to the muscle and lining of the gut. There are sensory neurons, motor neurons and neurons that connect between the other neurons (interneurons). Nerves communicate between each other and cause muscles to contract by releasing chemicals (transmitters). In the last decade, we have discovered that communication between the nerve and muscle cells occurs through a third cell type- interstitial cells of Cajal. These cells also have a role as pacemaker cells for the muscle cells. In a small study, we have found that the muscle can contract in response to transmitters but that activation of the nerves does not result in muscle contraction in NIDKIDs. This result shows that transmission from neurons to muscle is not occuring in large bowel from NIDKIDs. In this study, we will examine a larger group of patients to determine if a functional defect in the muscle, a defect in the nerve chemical transmitters or a lack of the intermediate cells (the interstitial cells of Cajal) is causing the problem in the NIDKIDs. Further treatment of each patient will be easier if the defect causing his-her problem is known. We would then be able to target their problem with drugs that would work specifically at the point of breakdown in their individual gut.