Abstract
Background: It is not clear what contribution the internal anal sphincter makes to the impaired
motility observed in patients with Hirschsprung's disease (HD). Neuropeptides have
recently been shown to be neurotransmitters in the nonadrenergic, noncholinergic inhibitory
and excitatory nerves in the human gut. To clarify the physiologic significance of
vasoactive intestinal polypeptide and substance P in the internal anal sphincter of
HD (aganglionosis), we investigated the enteric nerve responses on lesional and normal
internal anal sphincter muscle strips above the dentate line. Methods: The lesional and normal internal anal sphincter muscle strips above the dentate line
were derived from patients with HD (9 cases) and patients who underwent rectal amputation
for low rectal cancers (8 cases). A mechanographic technique was used to evaluate
in vitro muscle responses to these peptides of adrenergic and cholinergic nerves before
and after treatment with various autonomic nerve blockers. Results: Nonadrenergic, noncholinergic inhibitory nerves were found to act on the normal internal
anal sphincter but had no effect on the enteric nerves in aganglionosis. Peptidergic
(vasoactive intestinal polypeptide and substance P) nerves were found to act on normal
colon, but no effect was observed in the aganglionic internal anal sphincter. Conclusions: These findings suggest that peptidergic nerves play an important role in the impaired
motility observed in the internal anal sphincter with HD. (Surgery 1999;125:60-6.)
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Article info
Publication history
Accepted:
June 6,
1998
Footnotes
☆Reprint requests: Ryouichi Tomita, MD, First Department of Surgery, Nihon University School of Medicine, 30-1 Itabashi-ku, Ohyaguchi Kamimachi, Tokyo 173-0032, Japan.
Identification
Copyright
© 1999 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
