Rectal mucosal biopsy compared with laparoscopic seromuscular biopsy in the diagnosis of intestinal neuronal dysplasia in children with slow-transit constipation.
OBJECTIVE
Intestinal neuronal dysplasia (IND) as a cause for severe chronic constipation remains controversial. The aim of this study is to examine the correlation between a deficiency of substance P (SP) immunoreactive nerve fibers in the colon and enzyme histochemistry of rectal biopsies in children with slow-transit constipation.


METHODS
Fifty children with intractable constipation have been assessed by rectal biopsies examined with histochemical staining for lactate dehydrogenase, and 32 children among those 50 have been studied by laparoscopic seromuscular biopsy of the colon labelled with antibodies to SP using immunofluorescence methods.


RESULTS
Four children have evidence of IND. Fifteen children, including all 4 IND cases, showed a deficiency of SP immunoreactivity. There is a significant correlation between giant ganglia and SP deficiency (P <.01).


CONCLUSIONS
This study is attempting to propose that a deficiency of SP immunoreactivity in colonic circular muscle nerves may be used as a histologic marker for slow-transit constipation and that IND may be a small subset of patients with SP deficiency.
Imaji
R
R
F. Douglas Stephens Surgical Research Laboratory, Royal Children's Hospital Research Institute, Melbourne, Australia.
Kubota
Y
Y
Hengel
P
P
Hutson
J M
JM
Chow
C W
CW
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D005455:Fluorescent Antibody Technique; D005769:Gastrointestinal Motility; D006801:Humans; D007150:Immunohistochemistry; D007223:Infant; D007413:Intestinal Mucosa / Q000473:pathology*; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D008297:Male; D012007:Rectum / Q000473:pathology*
D007770:L-Lactate Dehydrogenase