Esophageal and gastric nitric oxide synthesizing innervation in primary achalasia
Esophageal and gastric nitric oxide synthesizing innervation in primary achalasia
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DOI：
10.1016/s0002-9270(99)00413-x
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发表时间：
1999-09-01
影响因子：
9.8
通讯作者：
Corinaldesi, R
中科院分区：
文献类型：
--
作者：
De Giorgio, R;Di Simone, MP;Corinaldesi, R
目的：对原发性贲门失弛缓症患者食管下括约肌（LES）和胃底食道和胃部分的氮能神经元进行定性和定量分析。方法：6例终末期贲门失弛缓症患者行食管胃肌切开术加半胃吻合术，从食管胃交界处取四条肌条（两条来自食管，两条来自LES胃侧），从胃底取两条肌条。对照标本取自8例接受胸段食道癌手术的患者。对固定切片进行NADPH-diaphorase组织化学处理，并在每个标本中视觉量化每张切片中氮能神经元的数量（平均+/- SE）。结果：在对照组中，一氧化氮纤维分布于腰腹大鼠和胃底的肌层和周围肌群神经元。相比之下，贲门失水患者在LES的食管和胃部分以及胃底的一氧化氮神经和标记神经元均明显减少。定量分析显示，与对照组（15 +/- 5个和12 +/- 4个）相比，食管（0.2 +/- 0.1个）和胃（2 +/- 0.6个）神经元的平均氮能神经元数量显著减少（p < 0.05）；胃底氮能神经元（3 +/- 1）较对照组（10 +/- 2）显著减少（p < 0.05）。结论：我们的研究结果表明，贲门失弛缓症是一种运动障碍，伴有LES的食管和胃部分以及近端胃的内在抑制性去神经支配，从而为该疾病的食管外延伸提供了进一步的证据。[J] .中华胃肠病杂志1999；19(4):559 - 563。(C) 1999 by Am。科尔。胃肠病学)。
OBJECTIVE: We performed a qualitative and quantitative analysis of the nitrinergic neurons in the esophageal and gastric component of the lower esophageal sphincter (LES) and gastric fundus of patients with primary achalasia.METHODS: Four muscle strips were obtained from the esophagogastric junction (two from the esophageal and two from the gastric side of the LES), and two from the gastric fundus of six patients with endstage achalasia who underwent an esophagogastric myotomy plus hemifundoplication. Control specimens were obtained from eight patients who underwent surgery for cancer of the thoracic esophagus. Fixed sections were processed for NADPH-diaphorase histochemistry and the number (mean +/- SE) of nitrinergic neurons per section was visually quantified in each specimen.RESULTS: In the controls, nitric oxide fibers were distributed to the muscle layer and surrounding myenteric neurons of both the LES and the gastric fundus. By contrast, achalasic patients showed a marked decrease of nitric oxide nerves and labeled neurons in both esophageal and gastric components of the LES and the gastric fundus. Quantitative assessment in achalasic patients showed that the mean number of nitrinergic neurons was dramatically reduced in both the esophageal (0.2 +/- 0.1) and the gastric component (2 +/- 0.6) of the LES as compared to those in controls (15 +/- 5 and 12 +/- 4, respectively; p < 0.05); nitrinergic neurons in the gastric fundus (3 +/- 1) were significantly reduced in comparison to those of controls (10 +/- 2) (p < 0.05).CONCLUSIONS: Our results indicate that achalasia is a motor disorder with an intrinsic inhibitory denervation of the esophageal and gastric component of the LES and of the proximal stomach, thus providing further evidence for an extraesophageal extension of the disease. (Am J Gastroenterol 1999;94:2357-2362. (C) 1999 by Am. Coll. of Gastroenterology).