35 Years of the Classification of Rezende: The Importance of Esophagogram in the Context of Chagas Disease in Brazil

Abstract

Achalasia is a disorder of the lower esophagus in which its sphincter is unable to relax even during a peristaltic reflex. Its development is related to the loss of both Auerbach's (myenteric) and Meissner's (submucous) plexuses of the distal esophagus and lower sphincter, due to a neurodegenerative process that may be autoimmune or secondary to an infection. In Brazil, Chagas disease is one of this disorder's main etiologies, by promoting the destruction of the myenteric plexus due an inflammatory response to the Trypanosoma cruzi. The Chagas megaesophagus is one of its presentations, consisting of the addition of achalasia to ineffective peristalsis that results in esophageal dilatation (1). The world's incidence of achalasia is about 1/100,000 and, because of its chronicity, its prevalence is about 9 to 10/100,000. It is estimated that, currently, about 1 million chronic Chagas patients live in Brazil. Megaesophagus affects about 7% to 10% of these patients, manifesting during about 20 to 40 years old (1-3). The main symptom of this condition is the long-lasting dysphagia, that may be followed by regurgitation, retrosternal pain, heartburn and sialorrhea. When facing symptoms like dysphagia, it is necessary, at first, to exclude diagnostic hypothesis of gastroesophageal reflux disease, mechanical obstruction of esophagus, or malignancy, since those are more prevalent; then, it must be proceeded the investigation of esophageal motility disorders, such as achalasia (4). Because of this illness' importance in our setting, and because of the need of accessible radiologic methods that allow diagnosis, classification and follow-up of patients, the barium-based contrast radiography of the esophagus (esophagogram) is still highlighted in the spite of more modern