Comparison of neuropeptide Y, protein gene product 9.5, and acetylcholinesterase in the diagnosis of Hirschsprung's disease

We compared the results of acetylcholinesterase (AChE) staining of mucosal rectal biopsy specimens with those using neuropeptide Y (NPY) and protein gene product 9.5 (PGP9.5) in biopsies from 68 patients. Thirty-three did not have Hirschsprung's disease (HD), 28 had proven HD, and biopsies from 7 patients had shown a slight increase in AChE stain but the patients did not have HD. In our hands, AChE stain was superior to the other two; it was easier to read and gave the most accurate results with no false-positive cases and only two instances in which the findings were suggestive but not diagnostic. Neuropeptide Y and PGP9.5 have the advantage that they can be used in paraffin-embedded material. With NPY, the results are closer than the PGP9.5 to those obtained with the AChE. Protein gene product 9.5 had the highest incidence of false-positive and false-negative results, but it stains nerve fibers and all neurons intensely and may be useful in the assessment of increased or decreased amounts of neural elements in the bowel.