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Histopathologic patterns among achalasia subtypes.

J B Sodikoff1, A A Lo2, B B Shetuni2

  • 1Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.

Neurogastroenterology and Motility
|November 7, 2015
PubMed
Summary

Achalasia subtypes show distinct histopathologic patterns, with type I exhibiting greater ganglion cell loss than type II, suggesting disease progression. This highlights achalasia

Keywords:
achalasiaesophagushistopathologyimmunohistochemistrymotility

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Area of Science:

  • Gastroenterology
  • Pathology
  • Surgical Gastroenterology

Background:

  • Achalasia presents with three distinct manometric phenotypes.
  • Understanding the underlying histopathologic differences is crucial for diagnosis and treatment.

Purpose of the Study:

  • To investigate the correlation between manometric achalasia subtypes and histopathologic findings.
  • To determine if distinct histopathologic patterns correspond to the three manometric phenotypes of achalasia.

Main Methods:

  • Retrospective analysis of 46 surgical muscularis propria biopsies from patients undergoing laparoscopic esophagomyotomy.
  • Manometry tracings were reviewed and categorized into Chicago Classification subtypes.
  • Pathology specimens were graded for neuronal loss, inflammation, fibrosis, and muscle changes.

Main Results:

  • Manometry types included I (n=20), II (n=20), III (n=3), and EGJOO (n=3).
  • Histopathology revealed complete ganglion cell loss in 74%, inflammation in 17%, and fibrosis in 11%.
  • Type I achalasia showed a significantly greater proportion and degree of aganglionosis compared to type II (p=0.044 and p=0.016, respectively).

Conclusions:

  • Type I achalasia may represent a more advanced stage of type II achalasia due to greater ganglion cell loss.
  • The spectrum of histopathologic findings underscores the pathogenic heterogeneity of achalasia.
  • Esophagogastric junction outflow obstruction is the common feature across all achalasia phenotypes.