HISTOPATHOLOGIC FEATURES IN ESOPHAGOMYOTOMY SPECIMENS FROM PATIENTS WITH ACHALASIA

Background & Aims: A previous study evaluating the morphological featu res of esophagi resected for endstage achalasia showed marked depletio n of myenteric ganglion cells, widespread destruction of nerves, and v ariable chronic inflammation. The aim of this study was to evaluate th e histological features in esophagomyotomy specimens from 11 patients with early achalasia, defined as minimal to moderate esophageal dilati on without sigmoid deformity. Methods:The histological features of eso phagomyotomy specimens from 11 patients with achalasia were analyzed a nd compared with the findings of control specimens obtained from 8 pat ients who underwent esophagectomy for intramucosal adenocarcinoma. Res ults: Control specimens had normal numbers of ganglion cells (0.70-0.9 1 ganglion cells per high-power field) and minimal inflammation. Three patients with vigorous achalasia had normal ganglion cell numbers (0. 79-0.91 ganglion cells per high-power field) and at least mild myenter ic inflammation without neural fibrosis. The remaining 8 patients had few or no ganglion cells (0-0.30 ganglion cells per high-power field) and at least mild myenteric inflammation and neural fibrosis. Ganglion itis was found in 2 cases. Ganglion cell number was inversely correlat ed with degree of myenteric: neural fibrosis (P < 0.001). Conclusions: Vigorous achalasia has pathological features that are distinct from c lassic achalasia, The earliest pathological changes consist of myenter ic inflammation with injury to and subsequent loss of ganglion cells a nd injury to and fibrosis of myenteric nerves.