Editorial
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World J Gastroenterol. Dec 14, 2011; 17(46): 5035-5048
Published online Dec 14, 2011. doi: 10.3748/wjg.v17.i46.5035
Neurogenic bowel dysfunction in patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson’s disease
Richard A Awad
Richard A Awad, Experimental Medicine and Motility Unit, Gastroenterology Service U-107, Mexico City General Hospital, 06726 México, DF, México
Author contributions: Awad RA solely contributed to this paper.
Correspondence to: Richard A Awad, MD, MSc, Head and Professor, Experimental Medicine and Motility Unit, Gastroenterology Service U-107, Mexico City General Hospital, Dr. Balmis No. 148, Col. Doctores, 06726 México, DF, México. awadrichardalexander@prodigy.net.mx
Telephone: +52-55-50043806 Fax: +52-55-50043806
Received: April 29, 2011
Revised: June 20, 2011
Accepted: June 27, 2011
Published online: December 14, 2011
Abstract

Exciting new features have been described concerning neurogenic bowel dysfunction, including interactions between the central nervous system, the enteric nervous system, axonal injury, neuronal loss, neurotransmission of noxious and non-noxious stimuli, and the fields of gastroenterology and neurology. Patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson’s disease present with serious upper and lower bowel dysfunctions characterized by constipation, incontinence, gastrointestinal motor dysfunction and altered visceral sensitivity. Spinal cord injury is associated with severe autonomic dysfunction, and bowel dysfunction is a major physical and psychological burden for these patients. An adult myelomeningocele patient commonly has multiple problems reflecting the multisystemic nature of the disease. Multiple sclerosis is a neurodegenerative disorder in which axonal injury, neuronal loss, and atrophy of the central nervous system can lead to permanent neurological damage and clinical disability. Parkinson's disease is a multisystem disorder involving dopaminergic, noradrenergic, serotoninergic and cholinergic systems, characterized by motor and non-motor symptoms. Parkinson's disease affects several neuronal structures outside the substantia nigra, among which is the enteric nervous system. Recent reports have shown that the lesions in the enteric nervous system occur in very early stages of the disease, even before the involvement of the central nervous system. This has led to the postulation that the enteric nervous system could be critical in the pathophysiology of Parkinson's disease, as it could represent the point of entry for a putative environmental factor to initiate the pathological process. This review covers the data related to the etiology, epidemiology, clinical expression, pathophysiology, genetic aspects, gastrointestinal motor dysfunction, visceral sensitivity, management, prevention and prognosis of neurogenic bowel dysfunction patients with these neurological diseases. Embryological, morphological and experimental studies on animal models and humans are also taken into account.

Keywords: Neurogenic bowel dysfunction; Spinal cord injury; Myelomeningocele; Multiple sclerosis; Parkinson's disease; Central nervous system; Enteric nervous system