Duffy, John Peter; (1995) Inflammation in Auerbach's plexus in motility disorders of the oesophagus. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Inflammation in Auerbach's plexus has been reported in motility disorders of the oesophagus. An eosinophil infiltrate has occasionally been described. Tissue eosinophilia is often pathogenic in diseases where it is present. Eosinophil granule proteins, such as eosinophilic cationic protein, are cytotoxic and neurotoxic. This thesis examines the inflammatory response, with specific attention to the role of eosinophils, in Auerbach's plexus in motility disorders of the oesophagus. Oesophageal muscle biopsies obtained at thoracotomy (including Auerbach's plexus) were stained with haematoxylin and eosin and examined. A new staining combination was developed to demonstrate eosinophils and mast cells in the same tissue section. Using computer-aided area measurement and manual counting, the number of cells per unit area was assessed in normal and diseased oesophagus. In biopsies with inflammation, eosinophil activation, and the distribution of T and B lymphocytes and cell-bound IgE were assessed using immunohistochemical staining. Nerve distribution and structure, and HLA-DR expression were similarly established. Peripheral blood eosinophil counts, serum IgE and eosinophilic cationic protein were estimated in patients with various motility disorders. Eosinophils were absent in normal oesophagus. Although present in the mucosa in severe reflux disease, they were uncommon in Auerbach's plexus. In some patients with disordered motility, eosinophil infiltration with degranulation and cellular activation was found. This was commonest in the vigorous contraction abnormalities diffuse oesophageal spasm and vigorous achalasia but was also seen less frequently in achalasia and nutcracker oesophagus. Peripheral blood eosinophil counts and eosinophilic cationic protein levels were normal in the vigorous contraction abnormalities. In some cases raised serum IgE, with IgE bearing cells and tissue eosinophilia in Auerbach's plexus were found. Eosinophil infiltrates in Auerbach's plexus are only seen in the motility disorders and are likely to be pathogenic. The inflammatory response has many of the features of an allergic disorder.

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