{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T17:57:06Z","timestamp":1785779826758,"version":"3.56.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100012681","name":"Universit\u00e4tsklinikum K\u00f6ln","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100012681","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Colorectal Dis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Chronic constipation comprises heterogeneous clinical entities, including slow-transit constipation (STC) and functional defecation disorders such as obstructed defecation syndrome (ODS). Although neuroenteric mechanisms are implicated, reproducible histomorphological correlates remain incompletely defined, partly due to methodological heterogeneity and lack of standardized quantification. The study characterizes the myenteric plexus morphology and neuroimmune cell distribution across clinically defined subgroups of functional bowel disorders using a standardized digital pathology approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Retrospective observational cohort study at a tertiary colorectal referral center. A total of 100 patients after bowel surgery were included: ODS (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200917), STC (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200924), combined ODS\u2009+\u2009STC (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200928), and a control cohort without clinically evident bowel motility disorders (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200931). Digital morphometric assessment of ganglionic density and morphology, neuronal content (immunohistochemistry against MAP2, HuC\/D), and the distribution of CD3-positive T-lymphocytes within and around myenteric ganglia were performed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Ganglionic density differed significantly between groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002), with increased density in ODS, whereas STC values were comparable to controls. Neuronal content per ganglion was preserved across all groups as demonstrated by MAP2 and HuC\/D analyses. In contrast, the presence of CD3-positive lymphocytes was reduced in all constipation groups, most pronounced in STC, affecting both the intra- and periganglionic compartments.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Functional bowel motility and defecation disorders appear to show distinct neuroarchitectural and neuroimmune patterns. Increased ganglionic density in ODS contrasts with preserved neuronal content and reduced presence of T-lymphocytes, particularly in STC. These findings represent associations rather than proven disease mechanisms, derived from comparison with a surgical rather than a healthy control cohort. Standardized digital morphometry nonetheless provides a reproducible framework for phenotypic characterization of chronic constipation and may support future studies linking enteric structure to function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Clinicaltrials.gov (NCT05016700; 09\/12\/2020).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00384-026-05209-4","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T17:19:46Z","timestamp":1785777586000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Distinct enteric nervous system pattern in obstructed defecation syndrome and slow-transit constipation: a controlled digital pathology study"],"prefix":"10.1007","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7510-2261","authenticated-orcid":false,"given":"Tillmann","family":"Bedau","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aryan","family":"Mirzaie-Kuzehgarani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5917-3560","authenticated-orcid":false,"given":"Joshy","family":"Madukkakzhy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6713-1334","authenticated-orcid":false,"given":"Luisa","family":"Halbe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3537-6011","authenticated-orcid":false,"given":"Alexander","family":"Quaas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3347-0108","authenticated-orcid":false,"given":"Claudia","family":"Rudroff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"5209_CR1","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1111\/j.1440-1746.2006.04333.x","volume":"21","author":"N Andromanakos","year":"2006","unstructured":"Andromanakos N, Skandalakis P, Troupis T, Filippou D (2006) Constipation of anorectal outlet obstruction: pathophysiology, evaluation and management. 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Ethical approval was obtained from the Ethics Committee of the North Rhine Medical Association (\u00c4rztekammer Nordrhein \u2013 Reference number: 2018344). The trial was registered with clinicaltrials.gov (NCT05016700).","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained for surgery, data collection, analysis, and publication for all patients prior to their first intervention.","order":2,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"During the preparation of this work, the authors used ChatGPT (OpenAI) to improve the readability and language of the manuscript (AI-assisted copy editing). After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.\u00a0All authors read and approved the final manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The final version reflects their original work.","order":3,"name":"Ethics","label":"Declaration of AI and AI-assisted assisted technologies in the writing process","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This manuscript has not been published previously and is not under consideration for publication elsewhere. The manuscript is approved by all authors and by the responsible authorities where the work was carried out. If our work will be accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically, without the written consent of the copyright holder.","order":4,"name":"Ethics","label":"Submission declaration and verification","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"127"}}