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

NIDKIDS是一个支持慢性便秘儿童的团体。在墨尔本的皇家儿童医院有200名患者属于这一组，因为他们的便秘对任何治疗都没有反应。食物沿着肠运动需要肠壁的肌肉以协调的方式收缩。肌肉收缩的协调是由神经系统提供的。控制肠道的神经系统具有位于肠壁内的细胞体，其将过程发送到肠道的肌肉和衬里。有感觉神经元、运动神经元和连接其他神经元的神经元（中间神经元）。神经之间相互沟通，并通过释放化学物质（递质）引起肌肉收缩。在过去的十年中，我们发现神经和肌肉细胞之间的交流是通过第三种细胞类型-卡哈尔间质细胞进行的。这些细胞也有作为肌肉细胞的起搏细胞的作用。在一项小型研究中，我们发现NIDKID患者的肌肉可以响应递质而收缩，但神经的激活不会导致肌肉收缩。这一结果表明，NIDKID在大肠中没有发生从神经元到肌肉的传递。在这项研究中，我们将检查一个更大的患者群体，以确定是否肌肉功能缺陷，神经化学递质缺陷或缺乏中间细胞（Cajal间质细胞）导致NIDKID的问题。如果知道导致他-她问题的缺陷，对每个病人的进一步治疗将更容易。然后，我们就可以针对他们的问题，使用药物，专门针对他们的肠道分解点。

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.