PubMed · 8048403
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M Costa, S J Brookes. 1994. The enteric nervous system.. https://pubmed.ncbi.nlm.nih.gov/8048403/
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Intestinal neuronal dysplasia (IND) is a well-documented but controversial entity defined as a congenital malformation of gastrointestinal innervation caused by dysplastic embryonal development of the enteric nervous system. Mainly described as a colonic disorder mimicking Hirschsprung's disease in the paediatric population, involvement of the ileum is rare. We report a case of fatal IND of the small intestine in a 58-year-old man presenting with a recent onset of features of small intestinal obstruction. IND has been described as a cause of colonic pseudo-obstruction and chronic constipation in adults, but to the best of our knowledge, this is the first report of IND of the ileum occurring in an adult causing fatal small bowel obstruction. A Medline search yielded no cases of ileal involvement with IND in adults.
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The pathophysiology of irritable bowel syndrome (IBS) is heterogeneous; it is possible for several mechanisms to be disturbed in the same patient. Isolating a single target for pharmacological manipulation is also difficult because of the complexity and overlap of the neural circuitry in the enteric and central nervous system. This review summarizes the rationale and efficacy of current and future therapies for IBS, on the basis of putative pathophysiological models. The modulation of gastrointestinal sensorimotor function, intestinal gas handling, the gastrocolonic reflex, neurohormonal stress responses, central processing of afferent information, and microbial flora are the current frontiers for experimental therapeutics for IBS. Patients presumed to have POSTINFECTIOUS IBS have also been targeted as a distinct group. In the very near future, it is unlikely that a single drug will come to the fore as a suitable and successful treatment for everyone with IBS, but new data on potential therapeutic targets lend hope for the improved long-term management of IBS. Disease modification rather than just symptom-based treatments must remain the goal.