Assessments of VIP and Substance P Nerves in the Aganglionic Internal Anal Sphincter for Hirschsprung's Disease

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It is not clear what contribution makes the internal anal sphincter (IAS) to the impaired motility observed in patients with Hirschsprung's disease (HD). Neuropeptides have recently been shown to be neurotransmitters in the non-adrenergic non-cholinergic inhibitory and excitatory nerves in the human gut. To clarify the physiological significance of vasoactive intestinal polypeptide (VIP) and substance P in the IAS of HD (aganglionosis), many researchers have investigated the enteric nerve responses on lesional and normal IAS above the dentate line in vitro. Especially, a mechanographic technique has been used to evaluate in vitro muscle responses to these peptides of adrenergic and cholinergic nerves before and after treatment with various autonomic nerve blockers. Following results have been reported. Non-adrenergic non-cholinergic inhibitory nerves are found to act on the normal IAS, but had no effect on the enteric nerves in aganglionosis. Peptidergic (VIP and substance P) nerves are found to act on normal IAS, but no effect is observed in the aganglionic IAS. According to these results, peptidergic nerves such as VIP and substance P play an important role in the impaired motility observed in the IAS of patients with HD.