Clinical correlation of esophageal and gastric pathologic changes in achalasia

Abstract

PURPOSE: 1) Characterize pathological changes in esophageal and gastric muscle biopsies of patients with achalasia. 2) Correlate these pathological changes with prospectively collected clinical and manometric parameters. METHODS: Full thickness biopsies taken from both esophageal (ESO) and gastric (GAS) aspects of myotomy during laparoscopic surgery from 47 patients with achalasia were studied via light microscopy with H&E staining. The pathologic features examined included: 1 ) number of ganglion cells 2) presence of ganglionitis 3) degree of myentenc inflammation. After excluding biopsies not containing adequate tissue, 47 ESO specimens and 34 GAS specimens were analyzed. Marm-Whimey test was used to correlate pathological findings with clinical and manometric parameters. Clinical parameters assessed a prospective, preoperative symptom questionnaire included age, disease duration, and symptom scores for dysphagia, chest pain, and regurgitation. Manometric parameters analyzed were basal lower esophageal sphincter (LES) pressure, relaxation LES pressure, esophageal body contraction amplitude and esophageal-gastric pressure gradient. RESULTS: Acha[asia patients with intact ganglion cells in ESO specimens had significantly higher esophageal body contractile amplitude and lower esophageal-gastric pressure gradient compared to those without ganglion cells (Table). Ganglion cell integrity was not associated with age, seventy of dysphagia or disease duration. The frequency of finding intact ganglion cells was significantly higher in gastric compared to esophageal specimens (47% vs 18%). No significant correlation was found between severity of inflammation or integrity of ganglion cells in GAS specimens and cfiincal/manometric parameters. CONCLUSIONS: (1) Achalasia patients with myenteric ganglion cells had greater esophageal function compared to those with agangfionosis. (2) Ganglion cell loss was significantly greater in the esophagus than in the proximal stomach consistent with relative site-specificity of the disease process.