Lower oesophageal sphincter response to pentagastrin in chagasic patients with megaoesophagus and megacolon.

Padovan, W.; Godoy, Renato Alves de; Dantas, Roberto Oliveira; Meneghelli, U. G.; Oliveira, R. B.; Troncon, L E A

doi:10.1136/gut.21.2.85

Cited by 19 publications

(18 citation statements)

References 29 publications

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“…The decrease in contraction amplitude in the distal esophagus is found in chagasic patients with or without megaesophagus [2,8,15]. A LES pressure lower than in controls is also found in patients with or without esophageal dilatation [10,16]. The increase in velocity of propagation of peristaltic contractions is a situation that may be the initial manifestation of aperistalsis.…”

Section: Discussionmentioning

confidence: 99%

Dysphagia in Patients with Chagas' Disease

Dantas

1998

Dysphagia

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Some patients with Chagas' disease and apparent normal esophageal function complain of dysphagia. With the objective of investigating the esophageal motility of these patients we studied the esophageal contraction amplitude, duration, velocity, and lower esophageal sphincter (LES) pressure of 34 patients with a positive serologic test for Chagas' disease, normal radiologic esophageal examination, peristaltic contractions in the esophageal body, and complete LES relaxation. Fourteen patients complained of dysphagia and 20 had no symptoms. The results were compared with those of 22 healthy controls. We used the manometric method with continuous perfusion. In patients without dysphagia, the LES pressure (17.8 +/- 1.2 mmHg, mean +/- SEM) and distal esophageal amplitude (71.8 +/- 7.9 mmHg) were lower than those of control subjects (24.3 +/- 1.8 mmHg and 100. 4 +/- 10.6 mmHg, respectively). The velocity of peristaltic contractions was higher in patients than in controls, but there was no difference between patients with or without dysphagia. The duration of contraction in the distal esophagus was longer in patients with dysphagia (3.9 +/- 0.2 sec) than in patients without dysphagia (3.1 +/- 0.2 sec) and controls (3.2 +/- 0.2 sec). We conclude that dysphagia in patients with Chagas' disease and a nondilated esophagus with peristaltic contractions and complete LES relaxation is related to a longer duration of contractions in the middle and distal esophageal body.

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Section: Discussionmentioning

confidence: 99%

Dysphagia in Patients with Chagas' Disease

Dantas

1998

Dysphagia

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“…Consequently lower esophageal sphincter pressure is frequently increased in idiopathic achalasia [14][15][16][17] and frequently decreased in Chagas' disease [16][17][18][19] which may explain the variation in the lower esophageal sphincter pressure [20] , and the heterogeneity seen in these patients [21] .…”

Section: Differences Between Idiopathic and Chagas' Disease Achalasiamentioning

confidence: 99%

“…Previous studies have reported differences in esophageal response to gastrin [14,15,18] and to atropine [15,22] . These mechanisms have not been completely elucidated in Chagas' disease [11,13] [ Table 1].…”

Section: Differences Between Idiopathic and Chagas' Disease Achalasiamentioning

confidence: 99%

Differences between idiopathic and chagasic achalasia

Dantas¹

2017

MIS

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Idiopathic and Chagas' disease achalasia are characterized by absent or partial lower esophageal sphincter relaxation, absence of peristaltic esophageal contraction, food retenction in the esophagus and esophageal dilatation. The most frequent symptoms are dysphagia, regurgitation, heartburn, weight loss and non-cardiac chest pain. The diagnosis is made by radiologic examination and esophageal manometry, which is considered the most accurate exam to characterized achalasia. In both diseases there is destruction of the esophageal myenteric plexus. Despite similarities in clinical and manometric presentation there is evidence of greater loss of inhibitory neurons of the myenteric plexus in idiopathic achalasia, whereas in Chagas' disease there is a loss of both excitatory and inhibitory neurons. Such differences, though do not affect patients' clinical presentation, and hence treatment options should be the same for both diseases. Key words:Achalasia, Chagas' disease, megaesophagus, dysphagia, esophageal denervation ABSTRACTArticle history:

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“…The presence of symptoms therefore appears to be associated with loss of peristalsis and failure of sphincter relaxation, leading to dilation. Studies of lower esophageal sphincter pressures in patients with Chagas' disease have demonstrated variable results (57,60,107,162,190,191,276). This contrasts with the uniformly elevated lower esophageal sphincter pressures in patients with idiopathic achalasia.…”

Section: Esophagusmentioning

confidence: 99%

“…There is decreased gastric secretion (190) and reduced acid and pepsin output in response to pentagastrin; this may be corrected by bethanechol (189). Approximately one-third of patients with gastrointestinal organomegaly and one-third of patients with cardiomyopathy are achlorhydric (86).…”

Section: Stomachmentioning

confidence: 99%

Chagas' disease

et al. 1992

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Chagas' disease, caused by Trypanosoma cruzi, is an important cause of morbidity in many countries in Latin America. The important modes of transmission are by the bite of the reduviid bug and blood transfusion. The organism exists in three morphological forms: trypomastigotes, amastigotes, and epimastigotes. The mechanism of transformation and differentiation is currently being explored, and signal transduction pathways of the parasites may be involved in this process. Parasite adherence to and invasion of host cells is a complex process involving complement, phospholipase, penetrin, neuraminidase, and hemolysin. Two clinical forms of the disease are recognized, acute and chronic. During the acute stage pathological damage is related to the presence of the parasite, whereas in the chronic stage few parasites are found. In recent years the roles of tumor necrosis factor, gamma interferon, and the interleukins in the pathogenesis of this infection have been reported. The common manifestations of chronic cardiomyopathy are arrhythmias and thromboembolic events. Autoimmune, neurogenic, and microvascular factors may be important in the pathogenesis of the cardiomyopathy. The gastrointestinal tract is another important target, and "mega syndromes" are common manifestations. The diagnosis and treatment of this infection are active areas of investigation. New serological and molecular biological techniques have improved the diagnosis of chronic infection. Exacerbations of T. cruzi infection have been reported for patients receiving immuno-suppressive therapy and for those with AIDS.

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Lower oesophageal sphincter response to pentagastrin in chagasic patients with megaoesophagus and megacolon.

Cited by 19 publications

References 29 publications

Dysphagia in Patients with Chagas' Disease

Dysphagia in Patients with Chagas' Disease

Differences between idiopathic and chagasic achalasia

Chagas' disease

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