{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T13:48:29Z","timestamp":1762004909163,"version":"3.41.2"},"reference-count":30,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,7,26]],"date-time":"2017-07-26T00:00:00Z","timestamp":1501027200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["16K19332."],"award-info":[{"award-number":["16K19332."]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Previously, the mucosal histology in achalasia has only been investigated using superficial biopsy or surgically resected esophageal specimens in end\u2010stage cases. We investigated the histology of the full\u2010layer mucosa in early and advanced achalasia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Endoscopy was performed for the pinstripe pattern (<jats:styled-content style=\"fixed-case\">PSP<\/jats:styled-content>) (an early achalasia indicator) and dilation and thickening of the mucosa (advanced achalasia indicators). A mucosal entry site for peroral endoscopic myotomy was created using cap\u2010fitted endoscopic mucosal resection to access the full\u2010layer mucosa and the submucosa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>Mucosal histology was compared between 32 patients with achalasia and 15 controls. Histological esophagitis with findings of inflammatory cell infiltration and dilated intercellular spaces was observed more in patients with achalasia than in controls (87.5% vs 13.3%, <jats:italic>P<\/jats:italic>&lt;.001; 84.4% vs 46.7%, <jats:italic>P<\/jats:italic>=.049). Muscularis mucosae (<jats:styled-content style=\"fixed-case\">MM<\/jats:styled-content>) atrophy and epithelial wave were only observed in achalasia (40.6% vs 0%, <jats:italic>P<\/jats:italic>=.005; 28.1% vs 0%, <jats:italic>P<\/jats:italic>=.043). Fibrosis was more common in achalasia, but without statistical significance (31.3% vs 20.0%, <jats:italic>P<\/jats:italic>=.503). In achalasia with endoscopic dilation and thickening of the mucosa, <jats:styled-content style=\"fixed-case\">MM<\/jats:styled-content> atrophy was observed histologically, and in cases involving endoscopic <jats:styled-content style=\"fixed-case\">PSP<\/jats:styled-content>, the histological epithelial wave was observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions &amp; Inferences<\/jats:title><jats:p>Histological findings of esophagitis were observed endoscopically even in early achalasia. Pinstripe pattern corresponds to the epithelial wave observed histologically in achalasia, whereas endoscopic findings in advanced achalasia correspond to <jats:styled-content style=\"fixed-case\">MM<\/jats:styled-content> atrophy. Appropriate management is necessary during early achalasia to prevent progression to advanced achalasia with more severe histological changes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.13168","type":"journal-article","created":{"date-parts":[[2017,7,26]],"date-time":"2017-07-26T13:21:49Z","timestamp":1501075309000},"source":"Crossref","is-referenced-by-count":9,"title":["Full\u2010layer mucosal histology in achalasia: Histological epithelial wave is characteristic in \u201cpinstripe pattern\u201d\u2010positive achalasia"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7766-3724","authenticated-orcid":false,"given":"H.","family":"Sato","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and\u00a0Hepatology Niigata University Medical and Dental Hospital  Niigata Japan"},{"name":"Division of Gastroenterology and Hepatology Saiseikai Niigata Daini Hospital  Niigata 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Medical and Dental Hospital  Niigata Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and\u00a0Hepatology Niigata University Medical and Dental Hospital  Niigata Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Ikarashi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and\u00a0Hepatology Niigata University Medical and Dental Hospital  Niigata Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K.","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and\u00a0Hepatology Niigata University Medical and Dental Hospital  Niigata Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Y.","family":"Honda","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and\u00a0Hepatology Niigata University Medical and 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