Eosinophil infiltration in primary esophageal achalasia

Abstract

Smooth-muscle specimens from the lower esophagus of nine patients operated on for esophageal achalasia were examined with routine hematoxylin-eosin staining. This procedure revealed only a few eosinophils in or between the external smooth-muscle layers. Using specific immunohistochemical methods for the detection of the eosinophil cationic protein (ECP), however, varying degrees of eosinophil infiltration and extracellular deposit of ECP were disclosed in the achalasia specimens. The ECP also reacted with the monoclonal antibody, EG2, indicating secretion of the cytotoxic ECP. Few or no eosinophils were seen in the muscularis externa in specimens from six control patients without esophageal disease. In two controls many eosinophils were observed in the muscularis externa. However, no extracellular ECP was detected and very few eosinophils reacted with the monoclonal antibody (EG2), suggesting that these eosinophils were not activated. Depletion or total absence of peptidergic innervation was seen in all achalasia specimens but not in controls. Since the eosinophil cationic protein (ECP), in its activated form, is cytotoxic, we propose a pathogenic role of the eosinophil infiltration in achalasia.

Esophageal Motor Disorders in Adults with Eosinophilic Esophagitis

“…Additionally, mast cells release histamine, which may also activate acetylcholine causing muscular contraction [12]. Furthermore, axonal necrosis, previously identified in achalasia patients, is believed to alter esophageal motility via an eosinophil mediated reaction [13].…”

Eosinophilic gastrointestinal disorders (EGID)☆

“…EE has been associated with esophageal dysmotility, and the cause of the motor disturbances is unclear, but eosinophil activation and degranulation has been postulated as a possible cause. 162,163 Recently, esophageal ultrasonography has revealed the presence of a dysfunctional muscularis mucosa in patients with EE, providing a possible explanation for the impaired esophageal dysmotility. 164 Radiographic and endoscopic studies have shown many findings, including strictures, mucosal rings, ulcerations, whitish papules, and polyps.…”

Idiopathic hypereosinophilic syndrome presenting with hepatitis and achalasia

“…Second arrow indicates the initiation of hydroxyurea. The third arrow indicates re-initiation of hydroxyurea and prednisone after a period of medication noncompliance eosinophils, in the esophageal specimens of patients with achalasia [14]. Per-oral esophageal myotomy is an emerging therapy for achalasia that has similar if not better outcomes compared to standard laparoscopic myotomy or pneumatic dilation [15].…”