Clin Endosc.  2018 Mar;51(2):161-166. 10.5946/ce.2017.087.

Retention Esophagitis as a Significant Clinical Predictor of Progression to Esophageal Cancer in Achalasia

• Kim H
• Park H
• Choi H
• Shin Y
• Park H
• Youn YH
• Kim JH

• KMID: 2410983
• DOI: http://doi.org/10.5946/ce.2017.087

Abstract

BACKGROUND/AIMS
Chronic liquid and/or food stasis caused by retention esophagitis (RE) in achalasia is a notable endoscopic finding because of the presence of a thickened or whitish esophageal mucosa and histologically altered squamous hyperplasia. We aimed to identify the clinical features of RE associated with achalasia and to clarify the clinical definition of RE in achalasia as a precancerous lesion identified by analyzing biomarker expressions.
METHODS
From 2006 to 2015, we retrospectively reviewed 37 patients with achalasia without previous treatment. Among them, 21 patients had diagnostic findings of RE (RE+) and 16 patients had no diagnostic findings of RE (RE−). Immunohistochemical staining of p53, p16, and Ki-67 was performed on the endoscopic biopsy tissues from the patients with achalasia and 10 control patients with non-obstructive dysphagia.
RESULTS
The symptom duration and transit delay were significantly longer in the RE+ group than in the RE− group. We found particularly high p53 positivity rates in the RE+ group (p<0.001). The rate of p16 expression was also significantly higher in the RE+ group than in the other two groups (p=0.003).
CONCLUSIONS
A high p53 expression rate was more frequently found in the RE+ group than in the other two groups. RE could be a meaningful clinical feature of achalasia for predicting esophageal carcinogenesis.

Keyword

Esophageal achalasia; Retention esophagitis; Esophageal neoplasms; Tumor suppressor protein p53

MeSH Terms

Biopsy
Carcinogenesis
Deglutition Disorders
Esophageal Achalasia*
Esophageal Neoplasms*
Esophagitis*
Humans
Hyperplasia
Mucous Membrane
Retrospective Studies
Tumor Suppressor Protein p53
Tumor Suppressor Protein p53

Figure

• 

  Fig. 1. Endoscopic diagnostic findings for retention esophagitis. (A) Liquid/foam stasis with mucosal thickening. (B) Food stasis with mucosal thickening. (C) Mucosal thickening. (D) Whitish change with food stasis.

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  Fig. 2. Histologic findings of retention esophagitis (arrow, squamous hyperplasia, hematoxylin and eosin stain, ×200).

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  Fig. 3. Level of p53 expression in retention esophagitis by study group. RE+, patients had diagnostic findings of retention esophagitis; RE–, patients had no diagnostic findings of retention esophagitis.

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