Comparison of idiopathic achalasia and Chagas' disease esophagopathy at the light of high-resolution manometry

Vicentine, Fernando Pompeu Piza; Herbella, Fernando A. M.; Allaix, Marco Ettore; Silva, Luciana C.; Patti, Marco G.

doi:10.1111/dote.12098

Cited by 25 publications

(15 citation statements)

References 30 publications

(44 reference statements)

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“…Alternatively, achalasia is a motility disorder, caused by lack of relaxation of the lower esophageal sphincter (LES). Despite presenting minor differences, both conditions share essentially an identical clinical presentation and response to treatment [8].…”

Section: Introductionmentioning

confidence: 99%

How does per-oral endoscopic myotomy compare to Heller myotomy? The Latin American perspective

et al. 2020

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Background and study aims Both Heller myotomy (HM) and per-oral endoscopic myotomy (POEM) are efficacious therapies for achalasia. The efficacy and safety of POEM vs HM in Latin America and specifically in patients with Chagas disease is unknown. Patients and methods Consecutive patients undergoing either HM or POEM for achalasia were included from nine Latin American centers in a prospective registry over 5 years. Technical success was defined as undergoing a successful myotomy. Clinical success was defined as achieving an Eckardt score < 3. Data on demographics, procedure info, Eckardt score, and adverse events (AEs) were collected. Student’s t test, Chi squared, and logistic regression analyses were conducted. Results One hundred thirty-three patients were included (59 male; 44 %; mean age 47). POEM was performed in 69 patients, HM in 64 patients. A total of 35 patients had Chagas disease, 17 of 69 in the POEM group, 18 of 64 in the HM group. Both groups had significant reduction in Eckardt scores (P < 0.00001), but successful initial therapy was significantly higher in the POEM group compared to the HM group (P = 0.01304). AEs were similar in both group (17 % vs 14 %) and consisted of pneumothorax (n = 3 vs 2), bleeding requiring transfusion (n = 3 vs 2), and mediastinitis (n = 3 vs 1). Hospital stay was longer in the HM group than in the POEM group (P < 0.00001). In the Chagas subgroup, post-procedure Eckardt score in the POEM group was significantly reduced by 5.71 points (P < 0.00001) versus 1.56 points in the HM group (P = 0.042793). Conclusion Both HM and POEM are efficacious for achalasia, but POEM was associated with higher initial therapy success and shorter hospital stay in Latin America. In Chagas patients with achalasia, POEM was significantly more effective than HM.

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Section: Introductionmentioning

confidence: 99%

How does per-oral endoscopic myotomy compare to Heller myotomy? The Latin American perspective

et al. 2020

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“…One limitation of this study is that we did not perform videofluoroscopic or manometric test in CG. However, previous manometric studies have well described changes in esophageal motility in CD patients 7,8,14 . Also, studies involving videofluoroscopic swallowing examination have shown that pharyngeal transit duration, sometimes named pharyngeal clearance, is longer in this population 9,11 .…”

Section: Discussionmentioning

confidence: 92%

“…Assessment of esophageal function in CD is performed by radiological examination 12,13 and conventional 8 or high-resolution manometry 14 . So far, studies of muscle electrical activity by surface electromyography (EMG) in patients with CD have not been performed.…”

Section: Introductionmentioning

confidence: 99%

Suprahyoid Muscle Activity in Patients with Chagasic Megaesophagus

Gharib

Berretin-Felix

Dantas

et al. 2019

Sci Rep

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The objective of this investigation was to evaluate the activity of the suprahyoid musculature during swallowing and to correlate the findings with the degree of megaesophagus, oral and pharyngeal videofluoroscopy and esophageal manometry in patients with achalasia caused by Chagas’ disease. Twenty-nine patients with positive serology for Trypanosoma cruzi and dysphagia (Chagas’ disease group) and 29 individuals matched by sex and age (control group) participated in the study. Surface electromyography of the suprahyoid musculature and videofluoroscopy during swallowing of paste and liquid consistencies were performed. Canonical correlation analysis of the MANOVA test results showed that the Chagas’ disease group had lower electromyographic activity when compared with controls. Overlapping circles of radiological findings were found for megaesophagus. The Spearman test showed a positive correlation between the electromyographic activity in the maximum voluntary isometric contraction and the time of pharyngeal transit for both liquid (p = 0.014) and paste (p = 0.047). The logistic regression test showed no association between electromyographic activity of the suprahyoid muscles and esophageal manometry results (p > 0.05). In conclusion, individuals with chagasic megaesophagus have reduced electromyographic activity of the suprahyoid muscles during swallowing, in addition to a greater recruitment of the suprahyoid musculature with increased pharyngeal transit time.

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“…All of them were performed in endemic countries. Two studies performed by Vicentine et al [ 23 , 24 ] in Brazil included patients with CD and dilatation of the esophagus and one study by Silva et al [ 25 ] also performed in Brazil selected patients with symptoms. These three studies cannot be compared with our study because their cohorts were selected among symptomatic patients or patients with achalasia-like esophagus.…”

Section: Discussionmentioning

confidence: 99%

High Resolution Esophageal Manometry in Patients with Chagas Disease: A Cross-Sectional Evaluation

et al. 2016

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IntroductionGastrointestinal involvement affects 30–40% of the patients with chronic Chagas disease. Esophageal symptoms appear once the structural damage is established. Little is known about the usefulness of high resolution manometry to early identification of esophageal involvement.MethodWe performed a cross-sectional study at the Vall d’Hebron University Hospital (Barcelona, Spain) between May 2011 and April 2012. Consecutive patients diagnosed with Chagas disease in the chronic phase were offered to participate. All patients underwent a structured questionnaire about digestive symptoms, a barium esophagogram (Rezende classification) and an esophageal high resolution manometry (HRM). A control group of patients with heartburn who underwent an esophageal HRM in our hospital was selected.Results62 out of 73 patients that were included in the study fulfilled the study protocol. The median age of the Chagas disease group (CG) was 37 (IQR 32–45) years, and 42 (67.7%) patients were female. Twenty-seven (43.5%) patients had esophageal symptoms, heartburn being the most frequent. Esophagogram was abnormal in 5 (8.77%). The esophageal HRM in the CG showed a pathological motility pattern in 14 patients (22.6%). All of them had minor disorders of the peristalsis (13 with ineffective esophageal motility and 1 with fragmented peristalsis). Hypotonic lower esophageal sphincter was found more frequently in the CG than in the control group (21% vs 3.3%; p<0.01). Upper esophageal sphincter was hypertonic in 22 (35.5%) and hypotonic in 1 patient. When comparing specific manometric parameters or patterns in the CG according to the presence of symptoms or esophagogram no statistically significant association were seen, except for distal latency.ConclusionThe esophageal involvement measured by HRM in patients with chronic Chagas disease in our cohort is 22.6%. All the patients with esophageal alterations had minor disorders of the peristalsis. Symptoms and esophagogram results did not correlate with the HRM results.

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Comparison of idiopathic achalasia and Chagas' disease esophagopathy at the light of high-resolution manometry

Cited by 25 publications

References 30 publications

How does per-oral endoscopic myotomy compare to Heller myotomy? The Latin American perspective

How does per-oral endoscopic myotomy compare to Heller myotomy? The Latin American perspective

Suprahyoid Muscle Activity in Patients with Chagasic Megaesophagus

High Resolution Esophageal Manometry in Patients with Chagas Disease: A Cross-Sectional Evaluation

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