Experience of acetylcholinesterase histochemistry application in the diagnosis of chronic constipation in children.

UNLABELLED The aim of this study was to review our experience in applying acetylcholinesterase histochemistry for diagnosing colonic dysganglionoses in children. PATIENTS AND METHODS We analyzed acetylcholinesterase histochemistry results of rectal biopsy specimens obtained from 85 children. The indications for biopsy were suspicion of Hirschsprung's disease in neonates and infants (Group 1; n=21) and older children (Group 2; n=17); megarectum (Group 3; n=44); and colostomy (Group 4; n=3). Specimens were taken at 5 and 10 cm using endoscopic forceps or excised with scissors at 2.5 cm above the dentate line. Acetylcholinesterase activity was evaluated using Karnovsky-Roots method. RESULTS The diagnosis of Hirschsprung's disease was confirmed in 17 children of the first group and in 3 of the second group. In the third group, 2 children were diagnosed with ultrashort-segment Hirschsprung's disease and 3 children with intestinal neuronal dysplasia. In one case, acetylcholinesterase reaction was false positive. Hirschsprung's disease was diagnosed in 2 children with colostomies; in one case acetylcholinesterase activity caused false-positive results. Colonic dysganglionoses were diagnosed in 78% of infants and in 14% of children over 1 year of age. The diagnostic specificity of acetylcholinesterase in Hirschsprung's disease was 92%. CONCLUSIONS 1) The analysis of acetylcholinesterase activity in children's rectal biopsy specimens is a reliable method for diagnosing Hirschsprung's disease, especially in infants; 2) This method of examination is irreplaceable in diagnosing ultrashort-segment Hirschsprung's disease and remains the only method to confirm the diagnosis of this disease; 3) Acetylcholinesterase histochemistry is not sufficiently informative in diagnosing intestinal neuronal dysplasia type B, because authors applying other neurohistochemical investigation methods have reported higher incidence of this disease.

[1]  W. Meier-Ruge.  Epidemiology of congenital innervation defects of the distal colon , 2006, Virchows Archiv A.

[2]  S. Moore,et al.  Acetylcholinesterase in Hirschsprung’s disease , 2005, Pediatric Surgery International.

[3]  W. Meier-Ruge,et al.  Diagnosis and Therapy of Ultrashort Hirschsprung's Disease , 2004, European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie.

[4]  W. Meier-Ruge,et al.  Updated Results on Intestinal Neuronal Dysplasia (IND B) , 2004, European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie.

[5]  P. Puri,et al.  What are the diagnostic criteria for intestinal neuronal dysplasia? , 1995, Pediatric surgery international (Print).

[6]  A. Peña,et al.  Intestinal neuronal dysplasia , 1995, Pediatric Surgery International.

[7]  W. Meier-Ruge,et al.  Histopathological criteria for intestinal neuronal dysplasia of the submucosal plexus (type B) , 2004, Virchows Archiv.

[8]  S. Huddart,et al.  The constipated child: how likely is Hirschsprung's disease? , 2003, Pediatric Surgery International.

[9]  A. Yamataka,et al.  Rectal biopsy: what is the optimal procedure? , 2002, Pediatric Surgery International.

[10]  A. Yamataka,et al.  Acetylcholinesterase distribution and refractory constipation – a new criterion for diagnosis and management , 2002, Pediatric Surgery International.

[11]  S. Suita,et al.  Fourteen-year experience of acetylcholinesterase staining for rectal mucosal biopsy in neonatal Hirschsprung's disease. , 2001, Journal of pediatric surgery.

[12]  F. Carneiro,et al.  Histochemical and immunohistochemical study of the intrinsic innervation in colonic dysganglionosis , 2001, Pediatric Surgery International.

[13]  B. Ure,et al.  Hirschsprung's disease and intestinal neuronal dysplasia – a frequent association with implications for the postoperative course , 1999, Pediatric Surgery International.

[14]  Holschneider,et al.  Rectal biopsy for diagnosis of intestinal neuronal dysplasia in children: a prospective multicentre study on interobserver variation and clinical outcome , 1999, Gut.

[15]  A. Ghosh,et al.  Rectal biopsy in the investigation of constipation , 1998, Archives of disease in childhood.

[16]  P. Puri.  Temporal stability of acetylcholinesterase staining in colonic and rectal neural tissue , 1998 .

[17]  J. Schnitzer,et al.  Surgical evaluation and management of refractory constipation in older children. , 1996, Journal of pediatric surgery.

[18]  W. Meier-Ruge,et al.  Rectal suction biopsy: can it be sufficient to diagnose neuronal intestinal dysplasia? , 1995, European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie.

[19]  W. Meier-Ruge,et al.  Acetylcholinesterase activity in suction biopsies of the rectum in the diagnosis of Hirschsprung's disease. , 1972, Journal of pediatric surgery.

[20]  H. Noblett.  A rectal suction biopsy tube for use in the diagnosis of Hirschsprung's disease. , 1969, Journal of pediatric surgery.

[21]  M. Karnovsky,et al.  A "DIRECT-COLORING" THIOCHOLINE METHOD FOR CHOLINESTERASES , 1964, The journal of histochemistry and cytochemistry : official journal of the Histochemistry Society.