The international surgical journal with global reach

This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Normalization of substance P levels in rectal mucosa of patients with faecal incontinence treated successfully by sacral nerve stimulation. BJS 2008; 95: 477-483.

Published: 6th February 2008

Authors: M. L. Gooneratne, P. Facer, C. H. Knowles, C. L. Chan, P. J. Lunniss, S. M. Scott et al.

Background

Sacral nerve stimulation (SNS) may improve faecal incontinence by modulating rectal sensation. This study measured changes in the peripheral expression of various neural epitopes in response to SNS.

Method

Rectal mucosal biopsies were taken from 12 patients before and after temporary SNS, and from ten responders at 90 days after permanent stimulation. Sections were immunostained for substance P, transient receptor potential vanilloid (TRPV) 1, vasoactive intestinal peptide (VIP) and calcitonin gene‐related peptide (CGRP). Levels were compared with those in nine continent controls.

Results

Baseline levels of percentage area immunoreactivities of substance P (median 0·51 (95 per cent confidence interval 0·31 to 0·73) versus 0·13 (0·07 to 0·27) per cent; P < 0·001) and TRPV1 (0·76 (0·41 to 1·11) versus 0·09 (0·04 to 0·14) per cent; P < 0·001), but not of VIP (1·26 (0·37 to 2·15) versus 1·28 (0·39 to 2·17); P = 0·943), were significantly greater than in controls. Successful SNS resulted in a significant decrease in substance P immunostaining after temporary (0·15 (0·06 to 0·51) per cent; P = 0·051) and permanent (0·17 (0 to 0·46) per cent; P = 0·051) stimulation. Immunoreactivity of TRPV1, VIP, CGRP and neural markers showed no qualitative change.

Conclusion

Patients with faecal incontinence demonstrate normalization of raised rectal mucosal substance P levels following successful SNS. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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