title: Absence of NADPH-diaphorase activity in internal anal sphincter (IAS) achalasia.
abstract: We studied the internal anal sphincter (IAS) muscle from 10 patients with achalasia and five normal controls using histochemical staining for NADPH-diaphorase and acetylcholinesterase (AChE). Normal control IAS muscle contained occasional AChE-positive nerve fibers, whereas IAS achalasia specimens demonstrated prominent AChE-positive nerve fibers in muscle layers. NADPH-diaphorase activity was strongly expressed in nerves in the normal IAS muscle but was absent or scanty in the muscle of patients with IAS achalasia. Our findings of increased AChE-positive nerves and the absence of NADPH-diaphorase activity taken in conjunction with reports of abnormal peptidergic innervation indicate that complex neural abnormalities occur in IAS achalasia. The primary event remains obscure, but it is possible that a single defect, such as nitrergic nerve depletion, may lead to compensatory changes in the other nerve fibers.
authors.affiliation: Children's Research Centre, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.
authors.forename: H
authors.initials: H
authors.lastname: Hirakawa
authors.forename: H
authors.initials: H
authors.lastname: Kobayashi
authors.forename: D S
authors.initials: DS
authors.lastname: O'Briain
authors.forename: P
authors.initials: P
authors.lastname: Puri
mesh_terms: D000110:Acetylcholinesterase / Q000032:analysis; D001003:Anal Canal / Q000294:innervation; D001004:Anus Diseases / Q000201:enzymology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D007223:Infant; D008297:Male; D009130:Muscle, Smooth / Q000201:enzymology / Q000294:innervation; D009252:NADPH Dehydrogenase / Q000032:analysis / Q000172:deficiency*; D009412:Nerve Fibers / Q000201:enzymology; D012018:Reflex; D013194:Staining and Labeling
chemical_list: D009252:NADPH Dehydrogenase; D000110:Acetylcholinesterase