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Abstract

Patients with Chagas' disease often have chest pain as a prominent symptom. The objective of this study was to compare the results of intraesophageal balloon distension in chagasic and nonchagasic patients with chest pain not caused by coronary obstruction. We studied 40 patients with chest pain and angiographically normal coronary arteries, 25 with a positive serologic test for Chagas' disease (Chagas group, 16 women, mean age 53+/-10 years), and 15 with a negative serologic test (control group, 11 women, mean age 46+/-10 years). All patients had radiologic and endoscopic examinations of esophagus, stomach, and duodenum, esophageal manometry with the acid infusion test in the distal esophagus, and intraesophageal balloon distension. None of them had esophageal dilation or any signs of cardiovascular disease. A 25-mm-long latex balloon located 10 cm above the lower esophageal sphincter was inflated and deflated over a period of 10 sec at 1-ml increments of air until the subjects reported chest pain or to a maximum volume of 20 mi. The test caused chest pain in 14 subjects in the control group (93%) and in 12 in the Chagas' disease group (48%, P < 0.05). The mean volume of air that caused chest pain was 10+/-3 ml in the control group and 15+/-4 ml in the Chagas' disease group (mean+/-SD, P < 0.05). The maximum intraesophageal pressure during the examination was higher in Chagas' disease patients with chest pain during balloon distension (60 +/- 21 mm Hg) than in patients who did not have chest pain (37 +/-18 mm Hg, P < 0.05) and did not differ from the control group (48+/-16 mm Hg, P > 0.05). With the other examinations there was no difference between groups or between patients with or without chest pain during the balloon distension test. Although esophagitis was observed in 47% of patients in the control group and in 40% of the Chagas' disease group, the acid infusion test was positive in 27% of patients in the control group and in 4% of patients in the Chagas' disease group. We conclude that, as compared to a group of patients with similar chest pain, chagasic patients are less sensitive to esophageal distension. Thus, it is unlikely that their chest pain is related to esophageal mechanisms.

Variability of Oral and Pharyngeal Transit Between Two Consecutive Swallows in Chagas’ Disease

“…Neurons of the brain stem contain the timing pattern-generating that governs the oral, pharyngeal, and esophageal phases of swallowing [ 11 ]. The loss of the esophageal myenteric plexus caused by the disease is a more important esophageal pathological alteration [ 1 ], having consequences of esophageal motility alterations [ 2 ], characteristics of no esophageal adaptation to the bolus [ 13 ] and impairment of esophageal sensitivity [ 14 ]. However, esophageal myenteric plexus has no participation in the control of oral and pharyngeal phases of swallowing.…”

Proximal esophageal contraction after induction of ineffective distal contraction by sildenafil in healthy volunteers

“…Patients with the disease show a presence and severity of esophageal symptoms (dysphagia, heartburn and regurgitation) that may not reflect the intensity of the alterations in esophageal motility [19]. In achalasia, a disease that causes loss of the esophageal myenteric plexus [20,21] and ineffective contractions in distal esophagus, there is no association with an increase in proximal contraction [20-22], perhaps because of the loss of esophageal sensitivity [23,24]. These results suggest that the proximal esophageal response to the decrease of distal contraction is mediated by esophageal sensitivity.…”