Abstract
A prospective study was performed in 17 patients with achalasia of the esophagus determining the manometric characteristics of the gastroesophageal sphincter, correlating in with hisotological analysis by biopsies taken during surgery at the distal narrowed segment of the esophagus, at the location of the sphincter. The histological findings were compared to 10 control cases. Presence or absence of ganglion cells at the Auerbach's plexuses and appearance of smooth muscle fibers were evaluated. Only one case (6%) had Chagas' disease. The mean sphincter pressure was 41 mm Hg, with incomplete relaxation in all patients. Histological analysis showed a complete disappearance of ganglion cells in 94% of the cases and a decrease in the number of neurons with marked chronic inflammatory cells in one case (6%). In all control cases, the ganglion cells were normal. Smooth muscle fibers were normal on light microscopy. No relationship was found between resting gastroesophageal sphincter pressure, length and relaxation, and histological findings at the distal esophagus. These findings suggest that the denervation in the majority of cases is located in the Auerbach plexus, with complete absence of ganglion cells and, therefore, absence of postganglionic nerve fibers.
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References
Pope CE: Motor disorders of the esophagus.In Gastrointestinal Disease, 2nd ed. Sleisenger and Fordtran (eds). Philadelphia, WB Saunders, 1979
Csendes A, Uribe P, Larraín A: Motility studies in fifty patients with achalasia of the esophagus. Am J Gastroenterol 62:333, 1974
Csendes A, Velasco N, Braghetto I: A prospective study comparing forceful dilatation and esophagomyotomy in patients which achalasia of the esophagus. Gastroenterology 80:789, 1981
Castell DO: Achalasia and diffuse esophageal spasm. Arch Intern Med 136:571, 1976
Grass FS: Pathologic changes in megaesophagus. Surgery 31:647, 1952
Lendrum FC: Anatomic features of the cardiac orifice of the stomach with special reference to cardiospasm. Arch Intern Med 59:474, 1937
Misiewicz JJ, Walker SL, Anthony PP, Gummer JWP: Achalasia of the cardia. Q J Med 38:17, 1969
Casella RR, Brown AL, Sayre GP, Ellis FH: Achalasia of the esophagus: Pathologic and etiologic consideration. Ann Surg 160:474, 1974
Smith B: The neurological lesions in achalasia of the cardia. Gut 11:388, 1970
Hurst AF, Rake GW: Achalasia of the cardia. Q J Med 23:491, 1930
Trounce JR, Deuchar AC, Kauntz R, Thomas GA: Studies in achalasia of the cardia. Q J Med 26:433, 1957
Adam CWM, Marples EA, Trounce JR: Achalasia of the cardia and Hirschprung's disease. The amount and distribution of cholinesterase. Clin Sci 19:473, 1960
Kramer P, Ingelfinger FJ: Esophageal sensitivity to Mecholil and cardiospasm. Gastroenterology 19:242, 1951
Heitmann P, Espinoza J, Csendes A: Physiology of the distal esophagus in achalasia. Scand J Gastroenterol 4:1, 1969
Cohen S, Lipshutz W, Hughes W: Role of gastrin supersensitivity in the pathogenesis of lower esophageal sphinter hypertension in achalasia. J Clin Invest 50:1241, 1971
Cannon WB: A law of denervation. Am J Med Sci 198:737, 1939
Earlam R: Pathophysiology and clinical presentation of achalasia. Clin Gastroenterol 5:73, 1976
Casella RR, Ellis FH, Brown AL: Fine structure changes in achalasia of the esophagus. I: Vagus nerves. Am J Pathol 46:279, 1965
Casella RR, Ellis FH, Brown AL: Fine structure changes in achalasia of the esophagus. II: Esophageal Smooth muscle. Am J Pathol 46:467, 1965
Cohen S, Fischer R, Tuch A: The site of denervation in achalasia. Gut 13:556, 1972
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Csendes, A., Smok, G., Braghetto, I. et al. Gastroesophageal sphincter pressure and histological changes in distal esophagus in patients with achalasia of the esophagus. Digest Dis Sci 30, 941–945 (1985). https://doi.org/10.1007/BF01308293
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DOI: https://doi.org/10.1007/BF01308293