Clinical, Radiographic, and Manometric Evolution of Esophageal Involvement by Chagas’ Disease

Abstract

The complete manifestation of esophageal Chagas' disease includes nonperistaltic contractions in the esophageal body, absent lower esophageal sphincter (LES) relaxation, and dilatation of the organ. However, some patients have a minor degree of esophageal denervation and esophageal motility that does not imply a diagnosis of achalasia. Our objective was to evaluate the evolution of esophageal involvement by Chagas' disease in 28 patients with dysphagia for solids and liquids and a positive serologic test for the disease, 14 with complete LES relaxation, 4 with partial (incomplete) LES relaxation, and 10 with absent LES relaxation; only 2 of them had mild dilatation. The patients (21 women), aged 43-74 years (median 60 years), were evaluated by clinical, radiographic, and manometric methods that were repeated 3-14 years (median 7 years) later. Dysphagia improved in 13 (46.4%) patients, was worse in 5 (17.9%), and did not change in 10 (35.7%). The radiographic examination did not change in 24 (85.7%) and was worse in 3 (10.7%). Esophageal manometry revealed a change from peristaltic to simultaneous contractions in 2 patients (7.1%), LES relaxation changed from complete to partial in 5 (17.9%), and from partial to absent in 2 (7.1%). There was no further clinical, radiographic, or manometric impairment in 15 (53.6%) patients. The symptom duration was longer and the age when they were evaluated was older in patients with no progression of the disease. We conclude that a conspicuous part of this group of patients with esophageal Chagas' disease and dysphagia had no progression of esophageal disease after 3-14 years. This possibility should be considered when making therapeutic decisions.

Postfundoplication Dysphagia Causes Similar Water Ingestion Dynamics as Achalasia

“…For classification of the esophageal involvement in achalasia, the examination was performed with anteroposterior radiograph obtained at a fixed distance (1.8 m) at 10 seconds (s) after the patients swallowed 200 mL of liquid barium sulfate. The result was considered normal if there was no barium in the esophagus, or grade I esophagopathy if there was retention of barium sulfate but the esophageal diameter was less than 4 cm, or grade II if there was esophageal retention and the esophageal diameter was between 4 and 7 cm (20) . Manometric examination was performed with a system of continuously water perfusion, which permitted the diagnosis of esophageal achalasia (8) .…”

Pathogenesis of Achalasia

“…6 또한 Trypanosoma cruzi 에 감염되어 근육신경절이 변성되어 이차성 식도이완불능증이 발생하는데 이를 Chagas병이라고 한다. [7][8][9] 특발성 식도이완불능증에서도 하부식도와 하부식도괄약근의 근육신경절에 존재하는 신경세포가 거의 보이지 않는데, 10 …”

Delayed Gastric Emptying for Semi-Solid Diets in Patients With Chagasic Megaesophagus

“…The prevalence of megaesophagus in patients chronically infected with Trypanosoma cruzi, the protozoan causing Chagas disease, varies from 5 -18%. 2,12 Megaesophagus is defined as a failure of the esophagogastric sphincter to relax upon swallowing, and failure of the esophageal body to contract appropriately because of degeneration of ganglion cells in the wall of that organ caused by Trypanosoma cruzi infection. Thus, the lower portion of the esophagus becomes abnormally enlarged.…”