Current epidemiological profile of Chagasic megaesophagus in Central Brazil

Souza, Diogo Henrique Saliba de; Vaz, Maria da Glória Merheb; Fonseca, Cristiano Rezio; Luquetti, Alejandro Ostermayer; Filho, Joffre Rezende; Oliveira, Ênio Chaves de

doi:10.1590/0037-8682-0065-2013

Cited by 26 publications

(14 citation statements)

References 13 publications

(20 reference statements)

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“…Digestive involvement, characterized by the presence of megacolon or megaesophagus, occurs in approximately 10% of the cases, but its prevalence appears to vary with the geographic origin of the patients and strain of parasite. [12,13]…”

Section: General Considerations: Transmission Epidemiology Naturmentioning

confidence: 99%

Developments in the management of Chagas cardiomyopathy

Tanowitz

Machado

Spray

et al. 2015

Expert Review of Cardiovascular Therapy

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Over 100 years have elapsed since the discovery of Chagas disease and there is still much to learn regarding pathogenesis and treatment. Although there are antiparasitic drugs available, such as benznidazole and nifurtimox, they are not totally reliable and often toxic. A recently released negative clinical trial with benznidazole in patients with chronic Chagas cardiomyopathy further reinforces the concerns regarding its effectiveness. New drugs and new delivery systems, including those based on nanotechnology, are being sought. Although vaccine development is still in its infancy, the reality of a therapeutic vaccine remains a challenge. New ECG methods may help to recognize patients prone to developing malignant ventricular arrhythmias. The management of heart failure, stroke and arrhythmias also remains a challenge. Although animal experiments have suggested that stem cell based therapy may be therapeutic in the management of heart failure in Chagas cardiomyopathy, clinical trials have not been promising.

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Section: General Considerations: Transmission Epidemiology Naturmentioning

confidence: 99%

Developments in the management of Chagas cardiomyopathy

Tanowitz

Machado

Spray

et al. 2015

Expert Review of Cardiovascular Therapy

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“…Even if in recent studies [13] dysphagia appeared as a specific and constant symptom in patients with megaesophagus, in general the symptoms of chronic digestive CD are non-specific, and there are numerous confounders, including other common infections [14], [15], megacolon at high altitude, and gastrointestinal problems related to the long-term consumption of coca leaves [16]–[18] or to migration-related changes in diet [19], [20] and stress. A diagnosis of CD may easily be missed if symptoms are not evaluated by a physician who knew of the epidemiology and the symptoms of the disease.…”

Section: Introductionmentioning

confidence: 99%

Characterization of Digestive Involvement in Patients with Chronic T. cruzi Infection in Barcelona, Spain

et al. 2014

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BackgroundDigestive damage due to Chagas disease (CD) occurs in 15–20% of patients diagnosed as a result of peristaltic dysfunction in some endemic areas. The symptoms of chronic digestive CD are non-specific, and there are numerous confounders. Diagnosis of CD may easily be missed if symptoms are not evaluated by a well trained physician. Regular tests, as barium contrast examinations, probably lack the necessary sensitivity to detect early digestive damage.Methods71 individuals with T. cruzi infection (G1) and 18 without (G2) coming from Latin American countries were analyzed. They were asked for clinical and epidemiological data, changes in dietary habits, and history targeting digestive and cardiac CD symptoms. Serological tests for T. cruzi, barium swallow, barium enema, an urea breath test, and esophageal manometry were requested for all patients.Principal findingsG1 and G2 patients did not show differences in lifestyle and past history. Fifteen (21.1%) of G1 had digestive involvement. Following Rezende criteria, esophagopathy was observed in 8 patients in G1 (11.3%) and in none of those in G2. Manometry disorders were recorded in 34 G1 patients and in six in G2. Isolated hypotensive lower esophageal sphincter (LES) was found in sixteen G1 patients (23.9%) and four G2 patients (28.8%). Achalasia was observed in two G1 patients. Among G1 patients, ineffective esophageal motility was seen in six (five with symptoms), diffuse esophageal spasm in two (one with dysphagia and regurgitation), and nutcracker esophagus in three (all with symptoms). There were six patients with hypertonic upper esophageal sphincter (UES) among G1. Following Ximenes criteria, megacolon was found in ten G1 patients (13.9%), and in none of the G2 patients.ConclusionsThe prevalence of digestive chronic CD in our series was 21.1%. Dysphagia is a non-pathognomonic symptom of CD, but a good marker of early esophageal involvement. Manometry could be a useful diagnostic test in selected cases, mainly in patients with T. cruzi infection and dysphagia in whose situation barium swallow does not evidence alterations. Constipation is a common but non-specific symptom that can be easily managed. Testing for CD is mandatory in a patient from Latin America with constipation or dysphagia, and if diagnosis is confirmed, megacolon and esophageal involvement should be investigated.

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“…The incidence of megaesophagus continues to be high in Brazil because of its association with Chagas disease. It is estimated that 5% to 8% of patients with Chagas disease develop megaesophagus [11]. Surgical interventions in these patients are associated with complications during the immediate postoperative period as a result of the use of general anesthesia and the fact that organ manipulation is done close to the lungs.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the effectiveness of preoperative outpatient pulmonary preparation in patients undergoing esophageal surgery

et al. 2018

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Introduction: Preoperative inspiratory muscle training (IMT) can minimize the occurrence of complications after esophagectomy. Objective: To evaluate the effects of preoperative IMT in patients undergoing esophageal surgery by determining respiratory muscle strength (PImax and PEmax), pulmonary function (FEV1, FVC, FEV1/FVC) and functional capacity by the 6-minute walk test (6MWT). Methods: Twenty-two patients were randomized into two groups: a control group (CG; n = 10) and an intervention group (IG; n = 12). Only IG performed IMT for a minimum period of 2 weeks. The assessments were conducted pre- and post-surgery. Results: An increase of PImax was observed in IG, but not in CG, in the second preoperative assessment (p = 0.014). Assessment on postoperative day 1 showed a reduction in maximal respiratory pressures in the two groups, but the reduction was more marked in IG (p < 0.05). Partial recovery of the variables evaluated was observed at discharge in the two groups. These variables had fully returned to initial values on postoperative day 30. The distance walked in the 6MWT was greater in IG, but the difference was not significant (p = 0.166). There was no difference in the frequency of pulmonary complications between groups. Conclusion: Preoperative IMT performed in our study improved inspiratory muscle strength but did not influence the postoperative pulmonary function or functional capacity of patients undergoing esophagectomy.

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Current epidemiological profile of Chagasic megaesophagus in Central Brazil

Cited by 26 publications

References 13 publications

Developments in the management of Chagas cardiomyopathy

Developments in the management of Chagas cardiomyopathy

Characterization of Digestive Involvement in Patients with Chronic T. cruzi Infection in Barcelona, Spain

Evaluation of the effectiveness of preoperative outpatient pulmonary preparation in patients undergoing esophageal surgery

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