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Ikeda H, Ihara E, Takeya K, Mukai K, Onimaru M, Ouchida K, Hata Y, Bai X, Tanaka Y, Sasaki T, Saito F, Eto M, Nakayama J, Oda Y, Nakamura M, Inoue H, Ogawa Y. The interplay between alterations in esophageal microbiota associated with Th17 immune response and impaired LC20 phosphorylation in achalasia. J Gastroenterol 2024; 59:361-375. [PMID: 38472375 DOI: 10.1007/s00535-024-02088-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/04/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Achalasia is an esophageal motility disorder with an unknown etiology. We aimed to determine the pathogenesis of achalasia by studying alterations in esophageal smooth muscle contraction and the associated inflammatory response, and evaluate the role of esophageal microbiota in achalasia development. METHODS We analyzed esophageal mucosa and lower esophageal sphincter (LES) samples, obtained from patients with type II achalasia who underwent peroral endoscopic myotomy. Esophageal conditioned media obtained from patients were transferred into the mouse esophagus to determine whether the esophageal intraluminal environment is associated with achalasia. RESULTS Approximately 30% of 20-kDa myosin light chains (LC20) was phosphorylated in LES from the control group under resting and stimulated conditions, whereas less than 10% of LC20 phosphorylation was detected in achalasia under all conditions. The hypophosphorylation of LC20 in achalasia was associated with the downregulation of the myosin phosphatase-inhibitor protein CPI-17. Th17-related cytokines, including IL-17A, IL-17F, IL-22, and IL-23A, were significantly upregulated in achalasia. α-Diversity index of esophageal microbiota and the proportion of several microbes, including Actinomyces and Dialister, increased in achalasia. Actinomyces levels positively correlated with IL-23A levels, whereas Dialister levels were positively associated with IL-17A, IL-17F, and IL-22 levels. Esophageal IL-17F levels increased in mice after oral administration of the conditioned media. CONCLUSIONS In LES of patients with achalasia, hypophosphorylation of LC20, a possible cause of impaired contractility, was associated with CPI-17 downregulation and an increased Th17-related immune response. The esophageal intraluminal environment, represented by the esophageal microbiota, could be associated with the development and exacerbation of achalasia.
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Affiliation(s)
- Hiroko Ikeda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan
| | - Eikichi Ihara
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan.
| | - Kosuke Takeya
- Faculty of Veterinary Medicine, Okayama University of Science, Ehime, Japan
| | - Koji Mukai
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan
| | - Manabu Onimaru
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Kenoki Ouchida
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshitaka Hata
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan
| | - Xiaopeng Bai
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan
| | - Yoshimasa Tanaka
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan
| | - Taisuke Sasaki
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Fumiyo Saito
- Faculty of Veterinary Medicine, Okayama University of Science, Ehime, Japan
| | - Masumi Eto
- Faculty of Veterinary Medicine, Okayama University of Science, Ehime, Japan
| | - Jiro Nakayama
- Laboratory of Microbial Technology, Division of Systems Bioengineering, Department of Bioscience and Biotechnology, Faculty of Agriculture, Graduate School, Kyushu University, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Haruhiro Inoue
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan
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Jankovic J, Milenkovic B, Simic A, Skrobic O, Valipour A, Ivanovic N, Buha I, Milin-Lazovic J, Djurdjevic N, Jandric A, Colic N, Stojkovic S, Stjepanovic M. Influence of Achalasia on the Spirometry Flow-Volume Curve and Peak Expiratory Flow. Diagnostics (Basel) 2024; 14:933. [PMID: 38732346 PMCID: PMC11083519 DOI: 10.3390/diagnostics14090933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Achalasia is an esophageal motor disorder characterized by aperistalsis and the failure of the relaxation of the lower esophageal sphincter. We want to find out whether external compression or recurrent micro-aspiration of undigested food has a functional effect on the airway. METHODS The aim of this research was to analyze the influence of achalasia on the peak expiratory flow and flow-volume curve. All of the 110 patients performed spirometry. RESULTS The mean diameter of the esophagus was 5.4 ± 2.1 cm, and nine of the patients had mega-esophagus. Seven patients had a plateau in the inspiratory part of the flow-volume curve, which coincides with the patients who had mega-esophagus. The rest of the patients had a plateau in the expiration part of the curve. The existence of a plateau in the diameter of the esophagus of more than 5 cm was significant (p 0.003). Statistical significance between the existence of a plateau and a lowered PEF (PEF < 80) has been proven (p 0.001). Also, a statistical significance between the subtype and diameter of more than 4 cm has been proved. There was no significant improvement in the PEF values after operation. In total, 20.9% of patients had a spirometry abnormality finding. The frequency of the improvement in the spirometry values after surgery did not differ significantly by achalasia subtype. The improvement in FEV1 was statistically significant compared to the FVC values. CONCLUSIONS Awareness of the influence of achalasia on the pulmonary parameters is important because low values of PEF with a plateau on the spirometry loop can lead to misdiagnosis. The recognition of various patterns of the spirometry loop may help in identifying airway obstruction caused by another non-pulmonary disease such as achalasia.
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Affiliation(s)
- Jelena Jankovic
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (B.M.); (I.B.); (N.D.); (A.J.)
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
| | - Branislava Milenkovic
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (B.M.); (I.B.); (N.D.); (A.J.)
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
| | - Aleksandar Simic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
- Clinic for Digestive Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Ognjan Skrobic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
- Clinic for Digestive Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Arschang Valipour
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna Health Care Group, 1210 Vienna, Austria;
| | - Nenad Ivanovic
- Clinic for Digestive Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Ivana Buha
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (B.M.); (I.B.); (N.D.); (A.J.)
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
| | - Jelena Milin-Lazovic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
- Institute for Medical Statistics and Informatics, University of Belgrade, 11000 Belgrade, Serbia
| | - Natasa Djurdjevic
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (B.M.); (I.B.); (N.D.); (A.J.)
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
| | - Aleksandar Jandric
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (B.M.); (I.B.); (N.D.); (A.J.)
| | - Nikola Colic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
- Center for Radiology and MR, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Stefan Stojkovic
- Clinic for Gastroenterohepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Mihailo Stjepanovic
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (B.M.); (I.B.); (N.D.); (A.J.)
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
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