ANTI-MYENTERIC NEURONAL ANTIBODIES IN PATIENTS WITH ACHALASIA - A PROSPECTIVE-STUDY

Achalasia is a motility disorder of the esophagus characterized by the loss of inhibitory neurons in the distal esophagus. Although idiopath ic in nature, autoimmune mechanisms have been proposed, and we set out to determine the presence of myenteric neuronal antibodies. We prospe ctively studied 18 patients with well-characterized achalasia (by clin ical, x-ray, and manometric evidence), nine with gastroesophageal refl ux disease, and analyzed the sera from 22 disease-free controls. Using double-label, indirect immunofluorescence techniques, rat esophageal and intestinal sections were double-labeled with sera (dilutions of 1: 50 to 1:400) from the three groups and with neurofilament antibody to localize neurons. Seven of 18 achalasia patients had sera that stained the majority of neurons within plexi in the esophageal and intestinal sections, including both NADPH diaphorase (nitric oxide synthase) -po sitive and -negative neurons. None of the gastroesophageal reflux pati ents or the controls showed staining. Neuronal antibodies in achalasia provide an attractive hypothesis to explain this diffuse; possibly im mune-based disorder.