Many gastrointestinal nematodes secrete large amounts of acetylcholinesterases. Antibodies are produced against these secreted acetylcholinesterases and appear to give some protection against infection with some nematodes. The theory that acetylcholinesterase secreted by gastrointestinal nematodes may act as a biochemical holdfast by reducing contractions of the alimentary system has not been substantiated; a vasoactive intestinal polypeptide-like protein is secreted by some species and may be the biochemical holdfast. Secreted acetylcholinesterases may alter host cell permeability, have an anti-coagulant role, affect glycogenesis, and/or be important in certain aspects of acetate and choline metabolism. Probably the most important role for acetylcholinesterase secreted by nematodes is immune modulation and/or reduction of inflammation in the vicinity of the nematode. The reason why some species of gastrointestinal nematodes resistant to benzimidazoles contain elevated amounts of acetylcholinesterase is unclear.