Achalasia: The Current Clinical Dilemma and Possible Pathogenesis

Jia, Xingyu; Chen, Songfeng; Zhuang, Qianjun; Tan, Niandi; Zhang, Mengyu; Chen, Yi; Wang, Jinhui; Xing, Xin; Xiao, Yinglian

doi:10.5056/jnm22176

Cited by 11 publications

(5 citation statements)

References 95 publications

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“…This proved that esophageal neurons are the site of VZV infection in achalasia [ 12 ]. At present, the mechanism by which HSV-1 causes achalasia is not fully understood, but there is evidence that achalasia may be an immune-mediated inflammatory disease in which the virus is a trigger [ 56 , 60 – 62 ]. Facco et al performed flow cytometry analysis of achalasia versus control esophageal tissue and demonstrated that lymphocyte infiltration was significantly elevated in the LES in achalasia and was represented by T cells.…”

Section: Gastrointestinal Dysfunction Due To Viral Infection Of Nervesmentioning

confidence: 99%

The mechanisms of nerve injury caused by viral infection in the occurrence of gastrointestinal motility disorder-related diseases

Li,

Chen,

Wang

et al. 2023

Virol J

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Gastrointestinal motility refers to the peristalsis and contractility of gastrointestinal muscles, including the force and frequency of gastrointestinal muscle contraction. Gastrointestinal motility maintains the normal digestive function of the human body and is a critical component of the physiological function of the digestive tract. At present, gastrointestinal motility disorder-related diseases are gradually affecting human production and life. In recent years, it has been consistently reported that the enteric nervous system has a coordinating and controlling role in gastrointestinal motility. Motility disorders are closely related to functional or anatomical changes in the gastrointestinal nervous system. At the same time, some viral infections, such as herpes simplex virus and varicella-zoster virus infections, can cause damage to the gastrointestinal nervous system. Therefore, this paper describes the mechanisms of viral infection in the gastrointestinal nervous system and the associated clinical manifestations. Studies have indicated that the means by which viruses can cause the infection of the enteric nervous system are various, including retrograde transport, hematogenous transmission and centrifugal transmission from the central nervous system. When viruses infect the enteric nervous system, they can cause clinical symptoms, such as abdominal pain, abdominal distension, early satiation, belching, diarrhea, and constipation, by recruiting macrophages, lymphocytes and neutrophils and regulating intestinal microbes. The findings of several case‒control studies suggest that viruses are the cause of some gastrointestinal motility disorders. It is concluded that one of the causes of gastrointestinal motility disorders is viral infection of the enteric nervous system. In such disorders, the relationships between viruses and nerves remain to be studied more deeply. Further studies are necessary to evaluate whether prophylactic antiviral therapy is feasible in gastrointestinal motility disorders.

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Section: Gastrointestinal Dysfunction Due To Viral Infection Of Nervesmentioning

confidence: 99%

The mechanisms of nerve injury caused by viral infection in the occurrence of gastrointestinal motility disorder-related diseases

Li,

Chen,

Wang

et al. 2023

Virol J

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“…Achalasia and Hirschsprung's disease are known to cause bowel pseudo-obstruction without organic stenosis. Abnormalities in the muscular interlaminar plexus of the intestinal tract may be associated with bowel pseudo- obstruction in both diseases [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Bowel pseudo-obstruction caused by goblet cell adenocarcinoma of the appendix: A case report

Okada,

Mukai,

Saito

et al. 2024

International Journal of Surgery Case Reports

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“…Thus, we had reasons to believe that the elevation of profilin-1 and transgelin-2 found in this study was caused by achalasia. Previous studies have proposed that achalasia might be an immune-mediated neurodegenerative disease ( 40 , 41 ). The results of using these 2 molecules as biomarkers for achalasia suggested their potential roles in the pathogenesis of achalasia as mediators of either immunological or neurodegenerative processes.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of Serum Markers as Noninvasive Diagnostic Methods for Achalasia

Jia,

Chen,

Hou

et al. 2023

Clin Transl Gastroenterol

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Background: Currently, the diagnosis of achalasia mainly relies on invasive or radioactive examinations. This study aimed to develop a noninvasive diagnostic method for achalasia based on specific serum markers. Methods: Serum levels of profilin-1, galectin-10, immunoglobulin heavy variable (IGHV) 3-9, vasodilator-stimulated phosphoprotein (VASP) and transgelin-2 were measured in achalasia patients and controls by enzyme linked immunosorbent assay. The diagnostic values and thresholds were determined by the receiver operating characteristic curve analysis. Then, dysphagia patients were prospectively enrolled to validate the ability of these molecules for achalasia diagnosing. Results: 142 achalasia patients and 50 non-achalasia controls (healthy volunteers (HVs) and reflux esophagitis (RE) patients) were retrospectively included. The serum levels of profilin-1, galectin-10 and transgelin-2 in achalasia patients were significantly higher than those in HVs and RE patients (p all < 0.001). Profilin-1, galectin-10 and transgelin-2 were of good performance in diagnosing achalasia, with optimal thresholds of 2171.2 pg/ml, 33.9 pg/ml and 1630.6 pg/ml, respectively. Secondly, 40 dysphagia patients were prospectively enrolled to the validation of achalasia. For profilin-1, the positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity were 100.0%, 64.5%, 45.0% and 100.0% respectively. The figures for transgelin-2 were 65.5%, 90.9%, 95.0% and 50.0%. When both increased, the PPV reached to 100.0%. When both indexes were normal, the NPV was 100.0%. Conclusions: Profilin-1 and transgelin-2 were promising biomarkers for achalasia diagnosis, and performed better in combination. Further multicenter studies are necessary to verify their application as preliminary screening tools for achalasia.

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Achalasia: The Current Clinical Dilemma and Possible Pathogenesis

Cited by 11 publications

References 95 publications

The mechanisms of nerve injury caused by viral infection in the occurrence of gastrointestinal motility disorder-related diseases

The mechanisms of nerve injury caused by viral infection in the occurrence of gastrointestinal motility disorder-related diseases

Bowel pseudo-obstruction caused by goblet cell adenocarcinoma of the appendix: A case report

Development and Validation of Serum Markers as Noninvasive Diagnostic Methods for Achalasia

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