title: Histochemical staining for intestinal dysganglionosis: over 30 years experience with more than 1,500 biopsies.
abstract: OBJECTIVE
  Intestinal dysganglionosis are a group of anomalies of the enteric nervous system that constitute infrequent but severe forms of constipation. Histochemical stainings are the gold standard diagnostic procedure for intestinal dysganglionosis. This study describes our experience with histochemistry in a large series of patients.
  
  
  METHODS
  Between 1977 and 2010, 1,589 biopsies from children with persistent chronic constipation were studied. The specimens were snap frozen, sectioned and stained with acetylcholinesterase (AChE), acetylcholinesterase counterstained with hematoxilin and succinic dehydrogenase (SDH) histochemical stainings.
  
  
  RESULTS
  Among the 1,589 biopsies, 946 (59.5%) were rectal biopsies, 242 (15.2%) were internal sphincter biopsies, 346 (21.8%) were intestinal mapping studies and 42 (2.7%) of them were colon specimens from surgical resections. From the rectal biopsy group, 544 (57.5%) patients were reported as normal. Hirschsprung disease was found in 163 (17.2%) patients with a median age at diagnosis of 8 months and a male to female ratio of 3:1. Intestinal neuronal dysplasia was found in 162 (17.2%) patients, hypoganglionosis in 3 (0.3%) of them and ganglioneuromatosis in 1 (0.1%). In 73 (7.7%) patients, the biopsy was not conclusive for different reasons. 34 out of the 42 resected colon specimens were Hirschsprung disease. Intestinal neuronal dysplasia was found in the proximal segment of the aganglionic bowel in 15 out of 34 (44%) patients. All the aganglionic resected colon specimens had a previous aganglionic rectal biopsy. There were no false positive results in this group.
  
  
  CONCLUSIONS
  Histochemical stainings continue to be the gold standard in the diagnosis of intestinal dysganglionosis. The combination of two histochemical staining techniques provides a high level of accuracy in the diagnosis of intestinal dysganglionosis.
authors.affiliation: Department of Biomedical Sciences, School of Medicine, Universidad de Vaparaíso, Edificio Bruno Ghünter, Hontaneda 2664, Valparaíso, Chile. sandra.montedonico@uv.cl
authors.forename: Sandra
authors.initials: S
authors.lastname: Montedonico
authors.forename: Patricio
authors.initials: P
authors.lastname: Cáceres
authors.forename: Natalia
authors.initials: N
authors.lastname: Muñoz
authors.forename: Hugo
authors.initials: H
authors.lastname: Yáñez
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ramírez
authors.forename: Bruno
authors.initials: B
authors.lastname: Fadda
mesh_terms: D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003106:Colon / Q000378:metabolism / Q000473:pathology; D003248:Constipation / Q000378:metabolism* / Q000473:pathology; D017615:Enteric Nervous System / Q000002:abnormalities* / Q000473:pathology; D005260:Female; D006627:Hirschsprung Disease / Q000175:diagnosis; D006801:Humans; D006965:Hyperplasia; D007150:Immunohistochemistry; D007223:Infant; D007410:Intestinal Diseases / Q000175:diagnosis*; D008297:Male; D012007:Rectum / Q000378:metabolism / Q000473:pathology*; D013368:Submucous Plexus / Q000473:pathology