Goldblum J R, Rice T W, Richter J E
Department of Anatomic Pathology, Cleveland Clinic Foundation, Ohio, USA.
Gastroenterology. 1996 Sep;111(3):648-54. doi: 10.1053/gast.1996.v111.pm8780569.
BACKGROUND & AIMS: A previous study evaluating the morphological features of esophagi resected for endstage achalasia showed marked depletion of myenteric ganglion cells, widespread destruction of nerves, and variable chronic inflammation. The aim of this study was to evaluate the histological features in esophagomyotomy specimens from 11 patients with early achalasia, defined as minimal to moderate esophageal dilation without sigmoid deformity.
The histological features of esophagomyotomy specimens from 11 patients with achalasia were analyzed and compared with the findings of control specimens obtained from 8 patients who underwent esophagectomy for intramucosal adenocarcinoma.
Control specimens had normal numbers of ganglion cells (0.70-0.91 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 myenteric 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. Ganglionitis was found in 2 cases. Ganglion cell number was inversely correlated with degree of myenteric neural fibrosis (P < 0.001).
Vigorous achalasia has pathological features that are distinct from classic achalasia. The earliest pathological changes consist of myenteric inflammation with injury to and subsequent loss of ganglion cells and injury to and fibrosis of myenteric nerves.
先前一项评估因终末期贲门失弛缓症而切除的食管形态学特征的研究显示，肌间神经节细胞明显减少、神经广泛破坏以及不同程度的慢性炎症。本研究的目的是评估11例早期贲门失弛缓症患者食管肌层切开术标本的组织学特征，早期贲门失弛缓症定义为食管有轻度至中度扩张但无乙状结肠样畸形。
分析11例贲门失弛缓症患者食管肌层切开术标本的组织学特征，并与8例因黏膜内腺癌接受食管切除术患者的对照标本结果进行比较。
对照标本的神经节细胞数量正常（每高倍视野0.70 - 0.91个神经节细胞）且炎症轻微。3例强力型贲门失弛缓症患者的神经节细胞数量正常（每高倍视野0.79 - 0.91个神经节细胞），至少有轻度肌间炎症且无神经纤维化。其余8例患者的神经节细胞很少或没有（每高倍视野0 - 0.30个神经节细胞），至少有轻度肌间炎症和神经纤维化。2例发现有神经节炎。神经节细胞数量与肌间神经纤维化程度呈负相关（P < 0.001）。
强力型贲门失弛缓症具有与经典贲门失弛缓症不同的病理特征。最早的病理变化包括肌间炎症伴神经节细胞损伤及随后的丢失，以及肌间神经损伤和纤维化。
