Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Am J Clin Pathol. 2021 Jul 6;156(2):278-287. doi: 10.1093/ajcp/aqaa239.
Although histologic features in biopsies suggesting a possibility of achalasia would be helpful diagnostically, such features remain unknown. The goal of this study was to explore the prevalence, histologic features, and immunophenotype of lymphocytic esophagitis (LyE) in achalasia biopsies.
The study group consisted of 57 patients with achalasia. Controls comprised 52 patients with severe gastroesophageal reflux disease (GERD) and normal esophageal motility. CD4/CD8 immunophenotype of lymphocytes was analyzed by immunohistochemistry.
LyE was identified in 30% (17/57) of patients with achalasia and 6% (3/52) of patients with GERD, indicating a strong association with achalasia (odds ratio, 6.94; 95% confidence interval, 1.90-25.38). LyE was focal in 59% (10/17) of the cases and diffuse in 41% (7/17). CD4 T-cell predominance over CD8 T cells was observed in 88% of patients with achalasia and LyE. T helper 1 (Th1) cells, but not T helper 2 cells, were expanded in CD4 T cells; in the absence of evident infection, this was compatible with the role of Th1 cells in organ-specific autoimmunity.
Achalasia should be considered in the differential diagnosis of clinical entities associated with CD4-predominant LyE. Additional studies to explore the significance of Th1 cells in achalasia-associated LyE are warranted.
虽然活检中提示可能存在贲门失弛缓症的组织学特征在诊断上会有所帮助，但这些特征仍不明确。本研究旨在探讨贲门失弛缓症活检中淋巴细胞性食管炎（LyE）的患病率、组织学特征和免疫表型。
研究组包括 57 例贲门失弛缓症患者。对照组包括 52 例严重胃食管反流病（GERD）且食管动力正常的患者。通过免疫组织化学分析淋巴细胞的 CD4/CD8 免疫表型。
在 57 例贲门失弛缓症患者中有 30%（17/57）和 52 例 GERD 患者中有 6%（3/52）发现 LyE，表明与贲门失弛缓症有很强的关联（比值比，6.94；95%置信区间，1.90-25.38）。LyE 在 59%（10/17）的病例中呈局灶性，在 41%（7/17）的病例中呈弥漫性。88%的贲门失弛缓症和 LyE 患者中观察到 CD4 T 细胞对 CD8 T 细胞的优势。在没有明显感染的情况下，这与 Th1 细胞在器官特异性自身免疫中的作用一致，即 Th1 细胞扩张。
在与 CD4 优势 LyE 相关的临床实体的鉴别诊断中应考虑贲门失弛缓症。需要进一步研究以探讨 Th1 细胞在贲门失弛缓症相关 LyE 中的意义。
