{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T18:04:24Z","timestamp":1789668264057,"version":"4.0.1"},"reference-count":13,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Clin Pathol"],"accepted":{"date-parts":[[2026,8,26]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Achalasia has been proposed as a muscle-predominant variant of eosinophilic or lymphocytic oesophagitis. Peroral endoscopic myotomy (POEM) enables direct biopsy of the oesophageal muscular layer. We assessed eosinophilic and lymphocytic infiltration in the distal oesophageal muscle.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analysed POEM patients without mucosal eosinophilia who underwent lower oesophageal sphincter biopsies over 42 months. Eosinophils (EOs) were quantified per mm\u00b2; lymphocytes and nerve tissue were assessed by CD3 and S-100 staining. Seven patients with proximal oesophageal cancer served as controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 141 patients (52.4% male; mean age 47.5 years), mean EO density was 0.4\/mm\u00b2; 10.6% had \u22651 EO\/mm\u00b2. CD3 staining was absent or minimal in most, with mild increases in 5.7%. Lymphocyte density correlated with achalasia subtype (p=0.03), but not with EOs or outcomes. Controls showed negligible inflammation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Lower oesophageal sphincter biopsies showed no significant eosinophilic or lymphocytic infiltration, arguing against an inflammatory myopathy as the basis of achalasia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jcp-2025-210419","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T17:20:25Z","timestamp":1789665625000},"page":"jcp-2025-210419","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["No eosinophilic and lymphocytic infiltration in lower oesophageal sphincter biopsies from achalasia patients"],"prefix":"10.1136","author":[{"given":"Alexander","family":"Ionov","sequence":"first","affiliation":[{"name":"Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki Birgit","family":"Werner","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2270-2495","authenticated-orcid":false,"given":"Thomas","family":"R\u00f6sch","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Glatzel","sequence":"additional","affiliation":[{"name":"Institute of Neuropathology, University Hospital Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Jacobsen","sequence":"additional","affiliation":[{"name":"Institute of Pathology, University Hospital Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Till Sebastian","family":"Clauditz","sequence":"additional","affiliation":[{"name":"Institute of Pathology, University Hospital Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Schachschal","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadi","family":"Younis","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany"},{"name":"Tel Aviv Sourasky Medical Center, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania","family":"Ruppenthal","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Mann","sequence":"additional","affiliation":[{"name":"Department of General, Abdominal and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Quaas","sequence":"additional","affiliation":[{"name":"Institute of Pathology, University Hospital Cologne, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Sehner","sequence":"additional","affiliation":[{"name":"Institute of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jocelyn","family":"de Heer","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"2026091710201738000_jcp-2025-210419v1.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60651-0"},{"key":"2026091710201738000_jcp-2025-210419v1.2","doi-asserted-by":"crossref","first-page":"7892","DOI":"10.3748\/wjg.v22.i35.7892","article-title":"New insights into the pathophysiology of achalasia and implications for future treatment","volume":"22","author":"Furuzawa-Carballeda","year":"2016","journal-title":"World J Gastroenterol"},{"key":"2026091710201738000_jcp-2025-210419v1.3","doi-asserted-by":"crossref","first-page":"1594","DOI":"10.1038\/s41395-018-0240-3","article-title":"Can Eosinophilic Esophagitis Cause Achalasia and Other Esophageal Motility Disorders?","volume":"113","author":"Spechler","year":"2018","journal-title":"Am J 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