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Pathology

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Lack of inhibitory ganglion cells result in imbalance of inhibitory and excitatory neurotransmitters (1,2).

  • Excitatory release acetylcholine
  • Inhibitory release vasoactive intestinal peptide (VIP) and nitric oxide (NO)

Macroscopically:

  • dilatation of the oesophagus with thickening of the wall can lead to irreversible aperistalsis and worsening obstructive symptoms (1)
  • secondary changes such as diverticulae and mucosal ulceration may occur

Microscopically:

  • reduction or absence of ganglion cells in the myenteric plexus (1,2)
  • changes secondary to denervation and stasis:
    • hypertrophy of the oesophageal smooth muscle
    • inflammatory changes in myenteric nerves (1)

Reference:

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