AN EVALUATION OF THE ROLE OF SUCTION RECTAL BIOPSY IN THE DIAGNOSIS OF INTESTINAL NEURONAL DYSPLASIA

Background: German pathologists have developed a consensus for histolo gical features of intestinal neuronal dysplasia. Methods: A blind reev aluation of ganglionic suction rectal biopsies from infants and childr en who initially presented with symptoms of intestinal dysmotility was made. Results: 84 of 411 specimens had sufficient depth of submucosa for adequate assessment. Questionnaires or clinical interviews were em ployed 3-5 years after biopsy in these 84 patients to assess the relat ionship between histological changes and persistent symptomology. Eigh teen children were lost to follow-up, 4 others had Hirschsprung's dise ase the study biopsy specimen having been taken from the pulled-throug h bowel after surgical resection of the aganglionic segment. The remai ning 62 patients were divided into three groups. There were six patien ts in group A (both obligatory criteria) and 28 in group B (nonessenti al, orjust one of the obligatory criteria), and 28 in group C (normal appearances). On follow-up, two of the 28 (7%) in group B, and six of the 28 (21%) in group C had persistent dysmotility symptoms. Conclusio ns: Histological criteria of the consensus of German Pathologists for intestinal neuronal dysplasia was unhelpful in predicting the clinical outcome and therefore, should not influence clinical management, As o ne of the obligatory criteria, hyperplasia of the submucosal plexus wa s significantly more common in neonates (<4 weeks), it is concluded th at this is an age-related variation.