Achalasia - An Autoimmune Inflammatory Disease: A Cross-Sectional Study

Idiopathic achalasia is a disease of unknown etiology. the loss of myenteric plexus associated with inflammatory infiltrates and autoantibodies support the hypothesis of an autoimmune mechanism. thirty-two patients diagnosed by high-resolution manometry with achalasia were included. twenty-six specimens from lower esophageal sphincter muscle were compared with 5 esophagectomy biopsies (control). immunohistochemical (biopsies) and flow cytometry (peripheral blood) analyses were performed. circulating anti-myenteric autoantibodies were evaluated by indirect immunofluorescence. herpes simplex virus-1 (hsv-1) infection was determined by in situ hybridization,rt-pcr,and immunohistochemistry. histopathological analysis showed capillaritis (51%),plexitis (23%),nerve hypertrophy (16%),venulitis (7%),and fibrosis (3%). achalasia tissue exhibited an increase in the expression of proteins involved in extracellular matrix turnover,apoptosis,proinflammatory and profibrogenic cytokines,and tregs and bregs versus controls (p < 0.001). circulating th22/th17/th2/th1 percentage showed a significant increase versus healthy donors (p < 0.01). type iii achalasia patients exhibited the highest inflammatory response versus types i and ii. prevalence of both anti-myenteric antibodies and hsv-1 infection in achalasia patients was 100% versus 0% in controls. our results suggest that achalasia is a disease with an important local and systemic inflammatory autoimmune component,associated with the presence of specific anti-myenteric autoantibodies,as well as hsv-1 infection. copyright © 2015 j. furuzawa-carballeda et al.