Caso de Doença de Chagas observado desde o período inicial da infecção, com aparecimento precoce de magaesôfago e megacolo

Rossi, Anis; Rezende, Joffre M.; Doles, Jarbas

doi:10.1590/s0037-86821968000600005

Cited by 7 publications

(4 citation statements)

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“…This could explain the higher frequency of idiopathic megaesophagus (achalasia) compared with idiopathic megacolon. It would also allow more severe denervation of the esophagus compared with the colon, favoring earlier onset of megaesophagus compared with megacolon 6 , 19 , 20 , 21 , despite the need for a higher degree of denervation in megaesophagus than in chagasic megacolon 1 , 2 , 3 , 4 , 14 .…”

Section: Discussionmentioning

confidence: 99%

Blood Vessels in Ganglia in Human Esophagus Might Explain the Higher Frequency of Megaesophagus Compared With Megacolon

Adad

Etchebehere

Jammal

2014

Rev. Inst. Med. trop. S. Paulo

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This study aimed to determine the existence of blood vessels within ganglia of the myenteric plexus of the human esophagus and colon. At necropsy, 15 stillborns, newborns and children up to two years of age, with no gastrointestinal disorders, were examined. Rings of the esophagus and colon were analyzed and then fixed in formalin and processed for paraffin. Histological sections were stained by hematoxylin-eosin, Giemsa and immunohistochemistry for the characterization of endothelial cells, using antibodies for anti-factor VIII and CD31. Blood vessels were identified within the ganglia of the myenteric plexus of the esophagus, and no blood vessels were found in any ganglia of the colon. It was concluded that the ganglia of the myenteric plexus of the esophagus are vascularized, while the ganglia of the colon are avascular. Vascularization within the esophageal ganglia could facilitate the entrance of infectious agents, as well as the development of inflammatory responses (ganglionitis) and denervation, as found in Chagas disease and idiopathic achalasia. This could explain the higher frequency of megaesophagus compared with megacolon.

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Section: Discussionmentioning

confidence: 99%

Blood Vessels in Ganglia in Human Esophagus Might Explain the Higher Frequency of Megaesophagus Compared With Megacolon

Adad

Etchebehere

Jammal

2014

Rev. Inst. Med. trop. S. Paulo

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“…Seus casos seriam de aperistalse do grupo I com acentuada alteração da dinâmica do órgão? Teria Carlos Chagas considerado como fase aguda um período maior do que consideramos hoje e, assim, haveria tempo para o aparecimento bastante precoce de megaesôfago, como nós mesmo já observamos em duas pacientes adultas 17,18 ? Também, embora o megaesôfago comumente apareça com a infecção já durando alguns lustros, crianças de mui tenra idade, portanto, com período inicial da infecção recente, podem apresentá-lo e essa precocidade pode ser evidenciada na forma congênita da doença de Chagas.…”

Section: Discussionunclassified

Estudo clínico-radiológico do esôfago e dos cólons na fase aguda da doença de Chagas com relato de três casos de remissão espontânea de aperistalse do esôfago do grupo I

Rassi

Rezende

2011

Rev. Soc. Bras. Med. Trop.

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RESUMOIntrodução: O esôfago e os cólons foram investigados em pacientes na fase aguda da doença de Chagas, entre 1956 e 1989. Métodos: A deglutição e o exame radiológico do esôfago foram explorados em 94 (90,4%) pacientes, sendo excluídas 10 crianças em virtude de tenra idade. O enema opaco foi realizado em 59 (56,7%) pacientes. Resultados: A deglutição foi referida como normal em 86 (91,5%) pacientes, 5 dos quais apresentaram aperistalse do grupo I, enquanto a disfagia incipiente foi referida por 8, dos quais 7 apresentaram exame radiológico normal e apenas um, aperistalse do grupo I. Um segundo exame radiológico, realizado em 4 dos 6 casos, 6 meses após o primeiro, mostrou-se normal em 3 e permaneceu inalterado em um, o único que recebeu tratamento (benzonidazol) e considerado como curado da infecção. O ritmo intestinal resultou normal em 96 (92,3%) pacientes, obstipado em 7 (6,7%) e diarreico em um (1%). O enema evidenciou resultado normal em 54 (91,5%) pacientes, dolicossigmoide em 4 (6,8%) e dolicorretomegassigmoide em um (1,7%), que a eletromanometria demonstrou ser de natureza funcional. Conclusões: Para explicar a regressão da aperistalse, aventaram os autores duas hipóteses que não se excluem. A primeira,é a de que o processo inflamatório intramural na fase inicial da infecção poderia interferir na motilidade esofagiana, enfraquecendo a onda peristáltica; com a regressão do processo inflamatório, o peristaltismo voltaria ao normal, desde que a desnervação fosse limitada; a segunda hipótese é a de que tenha havido real re-inervação, com recuperação normal da onda peristáltica. Palavras-chaves: Doença de Chagas. Fase aguda. Esôfago e cólons. ABSTRACT Introduction:The esophagus and colons of patients with acute Chagas disease were studied. Methods: Deglutition and radiological examination of the esophagus were assessed in 94 (90.4%) patients, 10 children were excluded due to their age. Intestinal transit was assessed in 59 (56.7%) patients. Results: Deglutition was normal in 86 (91.5%) patients, 5 of whom presented aperistalsis (group I). Incipient dysphagia was reported by 8 patients, 7 of whom normal barium swallowing, while only one presented esophageal aperistalsis (group I). A second radiological examination of the esophagus was performed in 4 of the 6 cases with aperistalsis 6 months after the initial test. It was normal in 3, and showed aperistalsis in one case, the only patient who was treated with benznidazole and considered cured of the infection. Intestinal transit was normal in 96 (92.3%) patients, constipated in 7 (6.7%), and diarrheic in one (1%). Barium enema was normal in 54/59 (91.5%), showed a dolichosigmoid in 4 (6.8%) and a dolichorectomegasigmoid in one (1.7%), of functional origin, according to the electromanometric results. Conclusions: To explain the regression of aperistalsis, 2 non-excluding hypothesis were postulated: the intramural inflammatory process, established during the acute phase, could interfere with esophageal motility by weakening the peristaltic waves; with the remis...

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“…Exceptionally, the onset of megaesophagus is even earlier in infants, for example, since it may appear in the congenital form of Chagas disease [3][4][5] and in the vector-borne form of the disease when the diagnosis of the initial period of infection is known [6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

Advanced megaesophagus (Group III) secondary to vector-borne Chagas disease in a 20-month-old infant

Rassi

Rezende

2012

Rev. Soc. Bras. Med. Trop.

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The authors report the case of a female infant with Group III (or Grade III) megaesophagus secondary to vector-borne Chagas disease, resulting in severe malnutrition that reversed after surgery (Heller technique). The infant was then treated with the antiparasitic drug benznidazole, and the infection was cured, as demonstrated serologically and parasitologically. After follow-up of several years without evidence of disease, with satisfactory weight and height development, the patient had her first child at age 23, in whom serological tests for Chagas disease yielded negative results. Thirty years after the initial examination, the patient's electrocardiogram, echocardiogram, and chest radiography remained normal.

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Caso de Doença de Chagas observado desde o período inicial da infecção, com aparecimento precoce de magaesôfago e megacolo

Cited by 7 publications

References 1 publication

Blood Vessels in Ganglia in Human Esophagus Might Explain the Higher Frequency of Megaesophagus Compared With Megacolon

Blood Vessels in Ganglia in Human Esophagus Might Explain the Higher Frequency of Megaesophagus Compared With Megacolon

Estudo clínico-radiológico do esôfago e dos cólons na fase aguda da doença de Chagas com relato de três casos de remissão espontânea de aperistalse do esôfago do grupo I

Advanced megaesophagus (Group III) secondary to vector-borne Chagas disease in a 20-month-old infant

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