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Are endoscopic biopsies likely to give any useful information in achalasia?
J.R. Goldblum (Cleveland)
Once a diagnosis of achalasia is established, information which can be gained from an endoscopic biopsy specimen is relatively limited. Numerous secondary extra-myenteric changes occur in the esophageal mucosa and submucosa in patients with achalasia, although these changes lack specificity. The mucosa is frequently diffusely hyperplastic, often with papillomatosis and basal cell hyperplasia [1], and resemble those seen in patients with gastroesophageal reflux (GER). Given the fact that GER should not occur in patients with achalasia in the absence of an esophagomyotomy [2], these reflux-type changes are likely due to stasis of esophageal contents. On the other hand, GER is a known complication of esophagomyotomy, with a reported incidence which ranges from 4% to almost 50% [3-5]. Given the overlapping histologic features of the squamous mucosa in patients with achalasia without prior treatment with esophagomyotomy and patients with achalasia with gastroesophageal reflux occurring as a complication of esophagomyotomy, a more objective method such as pH monitoring is necessary to document the presence of GER.
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