Summary
The histopathology of 40 cases of achalasia of the cardia, 6 cases of oesophageal spasm-incoordination and 4 cases of scleroderma was examined. Three cases of carcinoma and 6 cases of reflux oesophagitis were used as a control group. A nearly complete loss of myenteric ganglion cells was found in the upper thickened segment in achalasia. Some surviving ganglion cells were found in the lower segments in half the cases of achalasia; in two cases counts were normal in this segment. The occurrence of neuronal chromatolysis in 9 biopsies of achalasia supports the view that an active disease process was involved. The preganglionic parasympathetic fibres in two cases of achalasia were normal in appearance and number; this somewhat limited evidence tends to count against a primary disorder of the preganglionic neurone in this condition. The 6 cases of oesophageal spasm-incoordination showed similar neuronal loss to that in the lower segment in achalasia. Possibly “oesophageal spasm” represents an early stage or incomplete expression of achalasia. One case of scleroderma showed loss of ganglion cells, but the myenteric plexus was here involved by the disease process. None of the 9 cases in the control group showed any loss of ganglion cells or chromatolysis. Acute and chronic inflammation was not convincingly associated with loss of ganglion cells in either achalasia or oesophageal spasm.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Adams, C.W.M.: Disorders of neurones and neuroglia. In: Neurohistochemistry (C.W.M. Adams, ed.), pp. 403–436. Amsterdam: Elsevier 1965a
Adams, C.W.M.: Histochemistry of the cells in the nervous system. In: Neurohistochemistry (C.W.M. Adams, ed.), pp. 253–331. Amsterdam: Elsevier 1965b
Adams, C.W.M., Brain, R.H.F., Ellis, F.G., Kauntze, R., Trounce, J.R.: Achalasia of the cardia. Guy's Hosp. Rep. 110, 191–236 (1961)
Adams, C.W.M., Marples, E.A., Trounce, J.R.: Achalasia of the cardia and Hirschsprung's disease: the amount and distribution of cholinesterases. Clin. Sci. 19, 473–481 (1960)
Cassella, R.R., Brown, A.L. Jr., Sayre, G.P., Ellis, F.H. Jr.: Achalasia of the oesophagus. Ann. Surg. 160, 474–485 (1964)
Cohen, S., Fisher, R., Tuch, A.: The site of denervation in achalasia. Gut 13, 556–558 (1972)
Cross, F.S.: Pathologic changes in megaesophagus (esophageal dystonia). Surgery 31, 647 (1952)
Hurst, A.F., Rake, G.W.: Achalasia of the cardia (so-called cardiospasm). Quart. J. Med. 23, 491–507 (1929)
Lendrum, F.C.: Anatomic features of the cardiac orifice of the stomach with special reference to cardiospasm. Arch, intern. Med. 59, 474–511 (1937)
Misiewicz, J.J., Waller, S.L., Anthony, P.P., Gummer, J.W.P.: Achalasia of the cardia: pharmacology and histopathology of isolated cardiac sphincteric muscle from patients with and without achalasia. Quart. J. Med., N.S. 38, 17–30 (1969)
Sloper, J.C.: Idiopathic diffuse muscular hypertrophy of the lower oesophagus. Thorax 9, 136–146 (1954)
Smith, B.: The neurological lesion in achalasia of the cardia. Gut 11, 388–391 (1970)
Trounce, J.R., Deuchar, D.C., Kauntze, R., Thomas, G.A.: Studies in achalasia of the cardia. Quart. J. Med., N.S. 38, 17–30 (1969)
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Adams, C.W.M., Brain, R.H.F. & Trounce, J.R. Ganglion cells in achalasia of the cardia. Virchows Arch. A Path. Anat. and Histol. 372, 75–79 (1976). https://doi.org/10.1007/BF00429718
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00429718