Hitoshi Hirakawa, Hiroyuki Kobayashi, D. Sean O'Briain, Prem Puri

Absence of NADPH‐Diaphorase Activity in Internal Anal Sphincter (IAS) Achalasia

  • Gastroenterology
  • Pediatrics, Perinatology and Child Health
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SummaryWe 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.

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