Abstract
Objective To observe the histological features of muscular layers in different parts of esophagus of patients with achalasia (AC) and to explore the distribution and function of eosinophils in esophageal muscular layer in patients with AC. Methods From June 2015 to February 2016, 21 patients diagnosed with AC by endoscopy, barium meal and esophageal high resolution manometry, accepted peroral endoscopic myotomy (POEM) were enrolled. At the same period, nine patients with esophageal carcinoma who received esophagectomy were selected as controls. Muscular tissues of lower esophageal sphincter (LES), distal esophagus (5 cm above LES) and middle esophagus (10 cm above LES) of patients with AC and controls were taken for regular haematoxylin-eosin (H-E) staining to analyze degree of eosinophils infiltration. Nonparametric analysis and Chi-square analysis were used for statistical analysis. Spearman correlation analysis was used for analyzing correlations. Results The results of H-E staining indicated that different degree of eosinophil infiltration was found in 18(85.7%) patients with AC, and eosinophil counts in muscular layer were over 15 per high power field in five patients with AC (23.8%, 5/21). However, no eosinophils infiltration was found in esophageal carcinoma patients. Median numbers of eosinophil in muscular layer of LES, distal esophagus and middle esophagus were all higher than those of esophageal carcinoma group (4.0, 2.0 to 10.0 vs 1.0, 0 to 1.5; 4.0, 1.0 to 17.0 vs 1.0, 0.5 to 1.5; 6.0, 0.5 to 15.0 vs 0, 0 to 1.0), and the differences were statistically significant (Z=2.997, 2.476 and 2.504, all P 0.05). Additionally, number of eosinophils in muscular layer of different parts of esophagus was not correlated with age and disease course (r=0.434 and 0.639; P=0.282 and 0.088). Conclusion The wide distribution of eosinophils in muscular layer of esophagus in patients with AC may involve in the genesis and development of AC. Key words: Achalasia; Eosinophils; Peroral endoscopic myotomy; Esophageal motility disorders
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