Proximal and distal esophageal contractions in patients with vigorous or classic esophageal Chagas' disease

Abstract

-Background -Some patients with achalasia have distal esophageal contraction amplitude in the normal range, a condition called vigorous achalasia, and others have low contraction amplitude, a condition named classic achalasia. The difference in distal contraction amplitude may also be associated with a difference in proximal contraction amplitude. Aim -To study the proximal and distal esophageal contractions in patients with Chagas' disease. Material and Methods -We studied 28 patients with Chagas' disease, all with dysphagia and an esophageal radiologic examination with retention without dilation, and 18 controls. The patients with Chagas' disease had vigorous achalasia (distal amplitude over 34 mm Hg, n = 13) or classic achalasia (distal amplitude below 34 mm Hg, n = 15). We measured the contractions by the manometric method with continuous perfusion at 2, 7, 12 and 17 cm below the upper esophageal sphincter after five swallows of a 5 mL bolus of water. Results -There was no difference in proximal amplitude of contractions between classic or vigorous achalasia, and controls. In the proximal esophagus there was also no difference in duration or area under curve of contractions. In the distal esophagus, duration and area under curve were lower in classic than vigorous disease. Failed and simultaneous contractions were more frequent in patients than controls. Simultaneous contractions were seen more frequently in classic disease, and peristaltic contractions were seen more frequently in vigorous disease. Conclusion -We did not find differences in proximal esophageal contractions of patients with classical or vigorous esophageal Chagas' disease, except for the higher number of simultaneous contractions seen in classic disease.

Differences in response of the proximal esophagus to wet swallows in patients of Chagas’ disease and idiopathic achalasia

“…There are reports suggesting that in Chagas’ disease 5,6 and in idiopathic achalasia 7–15 there are some alterations of motility or transit in the pharyngeal‐esophageal transition. There is a decrease in proximal amplitude of contractions in idiopathic achalasia 7,8 but not in Chagas’ disease 6,7,17 . It is possible that in idiopathic achalasia and Chagas’ disease, there is some degree of impairment of the central nervous system control of swallowing.…”

Durchführung und Interpretation der Ösophagusmanometrie: Empfehlungen der Deutschen Gesellschaften für Neurogastroenterologie und Motilität (DGNM), für Verdauungs- und Stoffwechselerkrankungen (DGVS) und für Allgemein- und Viszeralchirurgie (DGAV)

“…Sie variiert bei Nassschlucken dementsprechend etwa von 2 -5 Sekunden, beträgt normalerweise aber auch distal nicht mehr als 6 s[22]. Eine deutlich verlängerte Kontraktionsdauer wird von einigen Autoren als ein Kriterium für eine hypertensive Motilitätsstörung gewertet[61]. Im Rahmen der konventionellen Manometrie gelten Kontraktionsamplituden zwischen 30 und 180 mmHg in Antwort auf 5-ml-Wasserschlucke als normal.Mindestens 9 von 10 solcher Wasserschlucke sollten normale peristaltische Kontraktionen hervorrufen.…”