Achalasia is a motor disorder of the oesopagus characterized by decrea
se in ganglion cell density in Auerbach's plexus. The cause of the les
ion is unknown. This is to repeat on the occurrence of autoimmune phen
omena in patients with achalasia, in particular circulating antibodies
against Auerbach's plexus and its possible meaning. IgG-antibodies ag
ainst Auerbach's plexus were determined by standard indirect immunoflu
orescence. Antibodies to the cytoplasm of Auerbach's plexus were found
in 37 of 58 patients with achalasia at variable stages of the disease
(I-IV) with a disease duration ranging from 1 to 20 years but only in
4 out of 54 healthy controls (specificity 93%, sensitivity 64%, p<0.0
001), and in none of 12 patients with Hirschsprung's disease as well a
s 12 patients with cancer of oesophagus and only in one of 11 patients
with peptic oesophagitis as well as in one of 13 patients with myasth
enia gravis. The present observations suggest that autoimmunity to Aue
rbach's plexus plays a role in the pathogenesis of achalasia, the mech
anism of action is unknown.