Nakajima N, Sato H, Takahashi K, Hasegawa G, Mizuno K, Hashimoto S, Sato Y, Terai S
Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata, Japan.
Division of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata, Japan.
Neurogastroenterol Motil. 2017 Mar;29(3). doi: 10.1111/nmo.12968. Epub 2016 Oct 3.
Histopathology of muscularis externa in primary esophageal motility disorders has been characterized previously. We aimed to correlate the results of high-resolution manometry with those of histopathology.
During peroral endoscopic myotomy, peroral esophageal muscle biopsy was performed in patients with primary esophageal motility disorders. Immunohistochemical staining for c-kit was performed to assess the interstitial cells of Cajal (ICCs). Hematoxylin Eosin and Azan-Mallory staining were used to detect muscle atrophy, inflammation, and fibrosis, respectively.
Slides from 30 patients with the following motility disorders were analyzed: achalasia (type I: 14, type II: 5, type III: 3), one diffuse esophageal spasm (DES), two outflow obstruction (OO), four jackhammer esophagus (JE), and one nutcracker esophagus (NE). ICCs were preserved in high numbers in type III achalasia (n=9.4±1.2 cells/high power field [HPF]), compared to types I (n=3.7±0.3 cells/HPF) and II (n=3.5±1.0 cells/HPF). Moreover, severe fibrosis was only observed in type I achalasia and not in other types of achalasia, OO, or DES. Four of five patients with JE and NE had severe inflammation with eosinophilic infiltration of the esophageal muscle layer (73.8±50.3 eosinophils/HPF) with no epithelial eosinophils. One patient with JE showed a visceral myopathy pattern.
CONCLUSIONS & INFERENCES: Compared to types I and II, type III achalasia showed preserved ICCs, with variable data regarding DES and OO. In disorders considered as primary esophageal motility disorders, a disease category exists, which shows eosinophilic infiltration in the esophageal muscle layer with no eosinophils in the epithelium.
原发性食管动力障碍中外肌层的组织病理学特征此前已有描述。我们旨在将高分辨率测压结果与组织病理学结果进行关联。
在经口内镜下肌切开术期间，对原发性食管动力障碍患者进行经口食管肌肉活检。进行c-kit免疫组化染色以评估 Cajal 间质细胞（ICC）。苏木精伊红染色和阿赞-马洛里染色分别用于检测肌肉萎缩、炎症和纤维化。
分析了 30 例患有以下动力障碍患者的切片：贲门失弛缓症（I 型：14 例，II 型：5 例，III 型：3 例）、1 例弥漫性食管痉挛（DES）、2 例流出道梗阻（OO）、4 例强力型食管（JE）和 1 例胡桃夹食管（NE）。与 I 型（n = 3.7±0.3 个细胞/高倍视野 [HPF]）和 II 型（n = 3.5±1.0 个细胞/HPF）相比，III 型贲门失弛缓症中 ICC 大量保留（n = 9.4±1.2 个细胞/HPF）。此外，仅在 I 型贲门失弛缓症中观察到严重纤维化，而在其他类型的贲门失弛缓症、OO 或 DES 中未观察到。5 例 JE 和 NE 患者中有 4 例有严重炎症，食管肌层有嗜酸性粒细胞浸润（73.8±50.3 个嗜酸性粒细胞/HPF），上皮无嗜酸性粒细胞。1 例 JE 患者表现为内脏肌病模式。
与 I 型和 II 型相比，III 型贲门失弛缓症显示 ICC 保留，DES 和 OO 的数据存在差异。在被视为原发性食管动力障碍性疾病中，存在一类疾病，其食管肌层有嗜酸性粒细胞浸润，而上皮无嗜酸性粒细胞。
