High resolution manometric findings in patients with Chagas' disease esophagopathy

Silva, Luciana C.; Vicentine, Fernando Pompeu Piza; Herbella, Fernando A. M.

doi:10.1016/s1995-7645(12)60006-6

Cited by 13 publications

(9 citation statements)

References 17 publications

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“…Here, we found decreased nitrergic innervation in infected individuals with megaesophagus. Previous studies have demonstrated the presence of achalasia in almost 100% of chagasic individuals with megaesophagus and also in some asymptomatic T. cruzi infected individuals [27,28]. Here, we demonstrated that a subgroup of individuals infected without megaesophagus also have a loss of nitrergic nerve fibers in the lower esophagus.…”

Section: Resultssupporting

confidence: 64%

“…It is well known that, like other cells, the number of ICCs is controlled by several factors that regulate proliferation and death and that ICCs continuously undergo apoptosis in the GI tract of healthy individuals [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Because neurons produce Stem Cell Factor (SCF), which activates the c-kit receptor and stimulates the proliferation, survival…”

Section: Resultsmentioning

confidence: 99%

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Decrease of Nitrergic Innervation in the Esophagus of Patients with Chagas Disease: Correlation with Loss of Interstitial Cells of Cajal

Nascimento¹,

Martins²,

Duarte³

et al. 2017

Int J Pathol Clin Res

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The pathogenesis of megaesophagus in chronic Chagas disease, which is caused by infection with the parasite Trypanosoma cruzi is compelling. Individuals with megaesophagus often present achalasia and disturbances of peristalsis and neuronal loss. Esophageal samples were obtained from 6 T. cruzi infected individuals with megaesophagus, 6 T. cruzi infected individuals without megaesophagus, and 6 noninfected individuals who underwent necropsy procedures. Using one antibody specific for neuronal Nitric Oxide Synthase (nNOS) and another specific for Protein Gene Product 9.5 (PGP-9.5), which is a pan-neuronal marker, we demonstrated the relative area of nitrergic innervation. Additionally, we analysed the area occupied by Interstitial Cells of Cajal (ICCs) with antibody specific anti-CD117. The analyses presented here show that the relative area of nitrergic innervation is reduced in T. cruzi infected individuals with megaesophagus. Furthermore, we demonstrated reduced CD117-immunostained areas in the esophagus of T. cruzi infected individuals. Statistical analyses revealed a positive correlation between the relative area of nitrergic innervation and the density of ICCs in the same infected individuals. Considering data from the literature, we raised the hypothesis that the loss of nitrergic nerve fibers and ICCs could be view as an interdependent phenomenon occurring in the esophagus of T. cruzi infected individuals and that it could contribute to peristalsis disturbances, to achalasia and to megaesophagus development.

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Section: Resultssupporting

confidence: 64%

Section: Resultsmentioning

confidence: 99%

Decrease of Nitrergic Innervation in the Esophagus of Patients with Chagas Disease: Correlation with Loss of Interstitial Cells of Cajal

Nascimento¹,

Martins²,

Duarte³

et al. 2017

Int J Pathol Clin Res

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“…To our knowledge, this is the first report of the utility of this new technology in this specific population. Although recently, Silva et al . describe HRM features in 16 symptomatic patients with Chagas disease esophagopathy; it is important to remark that in our population before the evaluation, all the subjects were considered ‘asymptomatic’ by themselves.…”

Section: Discussionmentioning

confidence: 98%

“…32 Reduced pressure in the LES in chagasic achalasia further demonstrates that both innervations, excitatory and inhibitory, are damaged in contrast to idiopathic achalasia, where the excitatory innervation is preserved, thereby causing the pressure to be higher than in the normal subjects. 12,32,33 In the study by Silva et al 23 using HRM in 16 symptomatic patients with Chagas disease esophagopathy, the majority of them had hypotensive or normotensive LES.…”

Section: Discussionmentioning

confidence: 99%

Esophageal motor disorders in subjects with incidentally discovered Chagas disease: a study using high-resolution manometry and the Chicago classification

et al. 2012

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In patients with chronic indeterminate Chagas disease, conventional manometry has shown that 25-48% had esophageal motor disorders. Recently, esophageal high-resolution manometry (HRM) has revolutionized the assessment of esophageal motor function. In this study, we performed esophageal HRM in a group of subjects with incidentally positive serological findings for Trypanosoma cruzi. In this prospective observational study, we evaluated subjects who had positive serological tests for Chagas disease detected during a screening evaluation for blood donation. All subjects underwent symptomatic evaluation and esophageal HRM with a 36 solid-state catheter. Esophageal abnormalities were classified using the Chicago classification. Forty-two healthy subjects (38 males) aged 18-61 years (mean age, 40.7 years) were included. When specific symptoms questionnaire was applied, 14 (33%) subjects had esophageal symptoms. Esophageal high-resolution manometry revealed that 28 (66%) of the subjects had an esophageal motility disorder according to the Chicago classification. Most common findings were hypocontractile disorders in 18 subjects (43%) and esophagogastric junction (EGJ) outflow obstruction in 6 (15%). Esophageal high-resolution manometry reveals that up to two thirds of the subjects with an incidental diagnosis of Chagas disease have esophageal abnormalities. This technology increases the detection and allows a more complete assessment of esophageal motor function in subjects infected with T. cruzi even in the early stages of the disease.

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“…Hypertonic LES, a criterion of Chagasic esophagopathy, [32], [33], [35], [36] was found in three patients in G1, all of whom had dysphagia. No cases were seen in G2.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Digestive Involvement in Patients with Chronic T. cruzi Infection in Barcelona, Spain

et al. 2014

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BackgroundDigestive damage due to Chagas disease (CD) occurs in 15–20% of patients diagnosed as a result of peristaltic dysfunction in some endemic areas. The symptoms of chronic digestive CD are non-specific, and there are numerous confounders. Diagnosis of CD may easily be missed if symptoms are not evaluated by a well trained physician. Regular tests, as barium contrast examinations, probably lack the necessary sensitivity to detect early digestive damage.Methods71 individuals with T. cruzi infection (G1) and 18 without (G2) coming from Latin American countries were analyzed. They were asked for clinical and epidemiological data, changes in dietary habits, and history targeting digestive and cardiac CD symptoms. Serological tests for T. cruzi, barium swallow, barium enema, an urea breath test, and esophageal manometry were requested for all patients.Principal findingsG1 and G2 patients did not show differences in lifestyle and past history. Fifteen (21.1%) of G1 had digestive involvement. Following Rezende criteria, esophagopathy was observed in 8 patients in G1 (11.3%) and in none of those in G2. Manometry disorders were recorded in 34 G1 patients and in six in G2. Isolated hypotensive lower esophageal sphincter (LES) was found in sixteen G1 patients (23.9%) and four G2 patients (28.8%). Achalasia was observed in two G1 patients. Among G1 patients, ineffective esophageal motility was seen in six (five with symptoms), diffuse esophageal spasm in two (one with dysphagia and regurgitation), and nutcracker esophagus in three (all with symptoms). There were six patients with hypertonic upper esophageal sphincter (UES) among G1. Following Ximenes criteria, megacolon was found in ten G1 patients (13.9%), and in none of the G2 patients.ConclusionsThe prevalence of digestive chronic CD in our series was 21.1%. Dysphagia is a non-pathognomonic symptom of CD, but a good marker of early esophageal involvement. Manometry could be a useful diagnostic test in selected cases, mainly in patients with T. cruzi infection and dysphagia in whose situation barium swallow does not evidence alterations. Constipation is a common but non-specific symptom that can be easily managed. Testing for CD is mandatory in a patient from Latin America with constipation or dysphagia, and if diagnosis is confirmed, megacolon and esophageal involvement should be investigated.

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High resolution manometric findings in patients with Chagas' disease esophagopathy

Cited by 13 publications

References 17 publications

Decrease of Nitrergic Innervation in the Esophagus of Patients with Chagas Disease: Correlation with Loss of Interstitial Cells of Cajal

Decrease of Nitrergic Innervation in the Esophagus of Patients with Chagas Disease: Correlation with Loss of Interstitial Cells of Cajal

Esophageal motor disorders in subjects with incidentally discovered Chagas disease: a study using high-resolution manometry and the Chicago classification

Characterization of Digestive Involvement in Patients with Chronic T. cruzi Infection in Barcelona, Spain

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