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The serum acetylcholinesterase (AChE) levels as an alternative diagnostic tool in pre-operative Hirschsprung's disease

  • Dennis Chrissandy Wasito ,
  • Iskandar Ali ,
  • Fransiska Kusumowidagdo ,
  • I Gusti Bagus Adria Hariastawa ,

Abstract

Background: The golden standard of Hirschsprung's disease diagnosis is through a histopathological examination of the aganglionic site. The significance of serum acetylcholinesterase (AChE) immunohistochemistry for diagnosing Hirschsprung's disease has been widely accepted. However, the study of serum AChE levels in Hirschsprung's disease patients is still scarce. We aimed to examine the serum levels of AChE in individuals with Hirschsprung's disease.

Methods: An analytical observational study with a cross sectional design was conducted on 29 patients with Hirschsprung's disease. We divided the patients into two groups: 14 in Hirschsprung's disease group and 15 in the control group. Serum AChE level was measured using the enzyme-linked immunosorbent assay (ELISA) method. The optimal cut-off value for detecting Hirschsprung’s disease was determined using the ROC analysis.

Results: The prevalence of Hirschsprung was higher in males than in females. The average AChE level in the Hirschsprung group was 95.89 ± 51.11 Units/mL, while the average level of AChE in the control group was 44.45 ± 33.40 Units/mL. The optimal cut-off value was 46.615 Units/mL. We found that this study's sensitivity, specificity, positive predictive value, negative predictive value, and accuracy values ​​were 83.3%, 70.6%, 66.7%, 85.7%, and 75.9%, respectively. There was a significant relationship between serum AChE levels and Hirschsprung's disease (p=0.004).

Conclusion: The AChE levels in blood serum can be used as an alternative diagnostic parameter for Hirschsprung's disease. Patients with Hirschsprung's disease had higher serum AChE levels than patients without Hirschsprung's disease.

References

  1. Poerwosusanta EE, Hariastawa IGBA, Setiawan A, Sulistiawati S, Ary Wibowo A. Correlation between the Initial-Surgery Age with The Hirschsprung’s Disease Patient Stooling Patterns in Ulin Hospital Banjarmasin, South Kalimantan, Indonesia In 2012-2015. Maj Biomorfologi. 2021;31(2):66-69.
  2. Fury ER, Athiyyah AF, Darma A. Diagnostic Accuracy of Recto-Sigmoid Index Evaluation on Barium Enema in Hirschsprung's Disease. Indian J Forensic Med Toxicol. 2020;15(1):1045–1051.
  3. Barmadisatrio B, Hariono H. Case Report: Secondary Laparoscopic Assissted Transanal Endorectal Pull-Through. A Pre-Eliminary Study. Folia Medica Indonesia. 2017 ;52(1):74–79.
  4. Neuvonen MI, Korpela K, Kyrklund K, Salonen A, de Vos W, Rintala RJ, et al. Intestinal Microbiota in Hirschsprung Disease. J Pediatr Gastroenterol Nutr. 2018;67(5):594-600.
  5. Ranuh R, Athiyyah A, Darma A, Risky V, Riawan W, Surono IS, et al. Effect of the probiotic Lactobacillus plantarum IS-10506 on BDNF and 5HT stimulation: role of intestinal microbiota on the gut-brain axis. Iran J Microbiol. 2019;11(2):145-150.
  6. Russell MB, Russell CA, Niebuhr E. An epidemiological study of Hirschsprung’s disease and additional anomalies. Acta Paediatr Int J Paediatr. 1994;83(1):68–71.
  7. Chia ST, Chen SCC, Lu CL, Sheu SM, Kuo HC. Epidemiology of Hirschsprung’s Disease in Taiwanese Children: A 13-year Nationwide Population-based Study. Pediatr Neonatol. 2016;57(3):201–206.
  8. Kessmann J. Hirschsprung's disease: diagnosis and management. Am Fam Physician. 2006;74(8):1319-1322.
  9. Yanagihara J, Iwai N, Tsuto T, Majima S. Acetylcholinesterase activity in rectal mucosa and blood in the diagnosis of Hirschsprung’s disease. Jpn J Surg. 1983;13(1):42–48.
  10. Kuvelkar N, D’Souza S, Vidhyashree K, Shankar G, Bukel M, Noronha S, et al. Estimation of plasma and RBC acetylcholinesterase in children: An evaluation tool for Hirschsprung’s disease? Indian J Pathol Microbiol. 2021;64(2):266–176.
  11. Haricharan RN, Georgeson KE. Hirschsprung disease. Semin Pediatr Surg. 2008;17(4):266-275.
  12. Okasora T, Okamoto E, Kuwata K, Toyosaka A, Ohashi S, Ueki S. Serum and Erythrocyte Acetylcholine Esterase in Hirschsprung’s Disease. 1983;(1):298–300.
  13. Chalkoo MA, Rashid A, Kakroo SM, Razvi SA, Wani AA. Role of Erythrocyte Acetylcholinesterase in the Diagnosis of Hirschsprung ’ s Disease. 2013;3(2):79–82.
  14. Szylberg L, Marszałek A. Diagnosis of Hirschsprung’s disease with particular emphasis on histopathology. A systematic review of current literature. Prz Gastroenterol. 2014;9(5):264–269.
  15. Ambartsumyan L, Smith C, Kapur RP. Diagnosis of Hirschsprung Disease. Pediatr Dev Pathol. 2019;2;23(1):8–22.
  16. Muise ED, Hardee S, Morotti RA, Cowles RA. A comparison of suction and full-thickness rectal biopsy in children. J Surg Res. 2016;201(1):149–155.
  17. Agrawal RK, Kakkar N, Vasishta RK, Kumari V, Samujh R, Rao KLN. Acetylcholinesterase histochemistry (AChE)--A helpful technique in the diagnosis and in aiding the operative procedures of Hirschsprung disease. Diagn Pathol. 2015;10:208.
  18. Moore SW, Johnson G. Acetylcholinesterase in Hirschsprung’s disease. Pediatr Surg Int. 2005;21(4):255–263.
  19. Boston VE, Cywes S, Davies MR. Serum and erythrocyte acetylcholinesterase activity in Hirschsprung’s disease. J Pediatr Surg. 1978;13(4):407–410.
  20. She YX, Shi CR, Chen JZ, Wu YL. Observation on erythrocyte acetylcholinesterase (AChE) in infants and children with Hirschsprung’s disease. J Pediatr Surg. 1984;19(3):281–284.
  21. Jannot A-S, Amiel J, Pelet A, Lantieri F, Fernandez RM, Verheij JBGM, et al. Male and female differential reproductive rate could explain parental transmission asymmetry of mutation origin in Hirschsprung disease. Eur J Hum Genet. 2012;20(9):917–920.
  22. Granéli C, Dahlin E, Börjesson A, Arnbjörnsson E, Stenström P. Diagnosis, Symptoms, and Outcomes of Hirschsprung’s Disease from the Perspective of Gender. Surg Res Pract. 2017;2017:1–8.
  23. Nugraha, HG, Miranti PI. Comparison of the sacral ratio between children with Hirschsprung disease and non-Hirschsprung. Bali Medical Journal. 2021;10(3):864-866.

How to Cite

Wasito, D. C., Ali, I. ., Kusumowidagdo, F. ., & Hariastawa, I. G. B. A. . (2022). The serum acetylcholinesterase (AChE) levels as an alternative diagnostic tool in pre-operative Hirschsprung’s disease . Bali Medical Journal, 11(3), 1543–1547. https://doi.org/10.15562/bmj.v11i3.3610

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Dennis Chrissandy Wasito
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Iskandar Ali
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Fransiska Kusumowidagdo
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I Gusti Bagus Adria Hariastawa
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BMJ Journal