Correlation of Clinical Symptoms With Neuromorphological Changes of the Colorectal Wall in Patients With a Bowel Evacuation Disorder
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Defecation Disorder
- Sponsor
- Evangelisches Klinikum Köln Weyertal gGmbH
- Enrollment
- 500
- Locations
- 1
- Primary Endpoint
- Neuropathological changes of the intestinal wall in patients with bowel evacuation disorder in correlation to clinical defecation score
- Status
- Recruiting
- Last Updated
- last year
Overview
Brief Summary
Constipation and defecation disorders affect about 15% of the European population and of those up to 30% of the patients over 65 years of age. For those affected, this is associated with major restrictions in quality of life and high health care costs .
The underlying causes of constipation and defecation are complex and only partially understood.
Intestinal (full wall) resections taken in clinical practice from these patients when conservative therapy has been exhausted show rarefaction of ganglion cell nests in the myenteric plexus and submucosal plexus as well as changes in cholinergic innervation.
Initial histopathological investigations suggest an inflammatory genesis of this rarefaction of ganglion cell nests, which will be further characterised/investigated in the context of this study on the basis of further histopathological and serological investigations. This may lead to novel therapeutic approaches that can causally treat the symptoms of those affected.
Detailed Description
Intestinal transit disorders (constipation/obstipation) and/or defecation disorders (expulsion disorders) are widespread symptoms in our culture, which, depending on their severity, can become a disease. Epidemiological studies show that up to 30% of the population over the age of 65 is affected. The suffering of those affected is usually very high. The patients are usually treated conservatively at first. The focus is on lifestyle changes, dietary adjustments and medication to support bowel movements. If the symptoms persist despite consistent conservative therapy, additional diagnostics such as laboratory tests, sonography and colonoscopy are performed. Further diagnostic steps include anal manometry, defecography and colon transit time. From 2015 onwards, the systematic neuropathological examination of whole-wall samples was performed on the bowel specimen of patients who were surgically treated for defecation disorders. In addition, in individual cases in which no bowel resection was indicated, rectal full-wall samples were taken to confirm the diagnosis and indication for sacral nerve stimulation (SNS) and examined neuropathologically in the same way. The intestinal wall was examined for ganglion cell nests in the myenteric plexus and the submucosal plexus in order to identify the pathophysiological cause of the transport disorder. The analysis showed rarefaction of the ganglion cell nests in the myenteric plexus and the submucosal plexus, as well as both a change in the cholinergic innervation and changes that suggest an autoimmune initiated process. Increasing evidence links gastroenteritic germs with chronic intestinal motility disorders, so that a Campylobacter or Yersinia infection could well be the trigger for the observed neuropathological changes. The aim of the study is to analyse the pathomechanism of chronic intestinal emptying disorders. Neuropathological findings on the plexus of the intestinal wall specimen are correlated to clinical findings measured by clinical scores in order to identify a diagnostic pattern.
Investigators
Claudia Rudroff
Head of the Department of Visceral Surgery and Functional Surgery of the lower GI Tract
Evangelisches Klinikum Köln Weyertal gGmbH
Eligibility Criteria
Inclusion Criteria
- •obstructive defecation disorder scheduled for surgery
- •must be able to undergo surgery
- •\> 18 years of age
- •informed consent
Exclusion Criteria
- •no defecation disorder
- •no surgery needed
- •unable to undergo surgery
- •≤ 18 years
- •no consent
Outcomes
Primary Outcomes
Neuropathological changes of the intestinal wall in patients with bowel evacuation disorder in correlation to clinical defecation score
Time Frame: 10 years
Clinical outcome measure by score: Altomare Score (name of initiator) score (minimum 0 to maximum 30 points; higher values mean worse outcome)
Secondary Outcomes
- Correlation of psychic health and neuropathological changes of the intestinal wall in patients with defecation disorder(10 years)
- Correlation of neuropathological changes of the intestinal wall in patients with bowel evacuation disorder and clinical defecation insufficiency (incontinence)(10 years)
- Correlation of anxiety scoring and neuropathological changes of the intestinal wall in patients with defecation disorder(10 years)
- Association of pathological findings for autoimmune activation with duration of symptoms according to medical history(questionaire at inclusion to study)
- Association of pathological findings for autoimmune reaction with an initiating event according to the medical questionaire(questionaire at inclusion to study)
- Correlation of abdominal discomforting symptoms and neuropathological changes of the intestinal wall in patients with bowel evacuation disorder(10 years)