Morphometric aspects of the submucous plexus in whole-mount preparations of normal human distal colon

Gastrointestinal Function Regulation by Nitrergic Efferent Nerves

“…The differences in the architecture of the myenteric plexus in patients older than 4 years suggest an altered function and motility of the appendix in the early years of life. Wester et al (1998b) found that the density of NADPH diaphorase-positive ganglion cells in the submucous plexus of human distal colon excised during postmortem examination from patients who died of non-GI diseases markedly decreased with age.…”

Enteric nervous system and developmental abnormalities in childhood

“…A single systematic study on the development of colonic motility was performed in premature rhesus primates, which showed that the normal newborn colon had responses to feeding similar to those seen in adult colon, whereas the response in the preterm primate is less robust, again suggesting that the colon response matures late in gestation [80]. Morphological data from human tissues suggest that the population of colonic enteric neurons begins to decline relatively early in life, with marked decreases in both submucosal and myenteric plexuses occurring as early as the fourth year of life [60,81]. This neurodegeneration of aging in the myenteric plexus continues with a further 37% reduction in the total population of neurons between ages 20-35 and 65 years [62].…”

“…Recent studies have found that the enteric nervous system continues to develop in the postnatal period. Wester et al [60] investigated the number of ganglion cells per ganglion and ganglion cell density in wholemount preparations of the submucous plexus of normal distal colon and found a marked decrease of ganglion cell density with increasing age, but the number of ganglion cells per ganglion remained constant [60,81]. It would be desirable with better knowledge of the enteric nervous system and also with quantitative diagnostic criteria of IND to distinguish normal variation from pathological conditions.…”

Intestinal Neuronal Dysplasia Type B: An Updated Review of a Problematic Diagnosis

“…The influences of age, site, section thickness, location in the submucosa (deep versus superficial), sample size, and staining method were highlighted by Wester et al, 20 who examined the size and density of submucosal ganglia in whole-mount preparations from a series of 29 pediatric cadaveric specimens. They used a combination of Cuprolinic blue (which binds to single-stranded RNA) to visualize all neurons and NADPH diaphorase histochemistry, which labels nitrergic neurons (8%-16% of total), almost all of which are situated in the deep submucosa.…”

“…However, many studies have shown that counting ganglion cells, like many quantitative exercises in surgical pathology, is extremely vulnerable to interobserver bias. 20,21,29 In 1999, a group of pathologists, which included Meier-Ruge, Coerdt, and other experienced IND B diagnosticians, examined their own interobserver variability. 5 They observed that their ''j values were close to the zero value expected by chance for the diagnoses normal and IND B'' and concluded that ''with current knowledge, rectal biopsy for diagnostic purposes should only be performed in constipated children for diagnosis of Hirschsprung's disease.''…”