O megaesôfago tratado cirurgicamente: perfil epidemiológico dos pacientes operados no Hospital de Clínicas da Universidade Estadual de Campinas entre 1989 e 2005

Abstract

A tripanossomíase americana descrita por Carlos Chagas em 1909 constitui, ainda hoje, um problema sócio-econômico nacional e regional que aflige, principalmente, os países do cone sul da América, prevalentemente. O nível endêmico decorreu, principalmente, devido à domiciliação dos vetores motivada por más condições de habitação, esgotamento de fontes alimentares ABSTRACTMegaesophagus is one of the manifestations of Chagas disease and surgical treatment is the approach that presents the best results. In this retrospective study, the epidemiological profile of patients operated in the Clinical Hospital of University of Campinas between 1989 and 2005 was evaluated with regard to: place of birth, place of residence, probable place of infection, age, degree of megaesophagus, etiology, duration and evolution of dysphagia, other diseases in association and the type of surgery chosen. The method used was to analyze the 390 medical files of these patients, at the hospital's medical archive service. The results made it possible to establish the endemic regions, place of birth and place of residence of the patients with Chagas disease attended at our clinic, and to characterize the group. After detailed analysis, it was found that the mean age was 47 years and the mean duration of dysphagia was 9.47 years. It was observed that: a) in 84.4% of the patients, dysphagia took hold progressively; b) 306 (78.5%) patients presented Chagas disease etiology; c) grade 2 was prevalent in 48%; d) 89.8% of the patients underwent cardiomyotomy; and e) there were frequent associations with gastritis, esophagitis, megacolon, arterial hypertension and cardiopathy. Key-words:Megaesophagus. Chagas disease. Cardiomyotomy. Idiopathic achalasia of the esophagus. Esophagus.originais (ação antrópica destrutiva) e características dos vetores (fototropismo e hematofagia) 13 .O Banco Mundial (World Development Report, 1993) estudou o peso relativo da doença de Chagas, comparado ao de outras enfermidades transmissíveis endêmicas na América Latina e Caribe, e avaliou os pacientes chagásicos quanto aos anos de

Current epidemiological profile of Chagasic megaesophagus in Central Brazil

“…Regurgitation, halitosis, pyrosis and chest pain were present in more than 60% of the cases. Other epidemiological studies 7,19,21 have reported similar symptoms.…”

“…In 2 previous studies that were also performed in Goiás, Rezende 13 and Rezende and Luquetti 18 also found a greater prevalence of CM patients in Groups II and III, as did Oliveira et al 19 in a study performed in Campinas. Therefore, a change in the proportion of patients in each of the CM groups has occurred, and there is a higher prevalence of patients in CM groups with less advanced disease and smaller dilation (Groups I and II).…”

“…Regarding distribution by gender, similar to the fi ndings of Rezende 13 , Rezende and Luquetti 18 and Vaz et al 21 , this study found that males were generally more prevalent (54% of cases) relative to females (46% of cases). However, studies performed by Kamiji and Oliveira 20 and Almeida et al 24 demonstrated a greater prevalence of female patients, and Peñaranda-Carrillo et al 25 and Oliveira et al 19 did not observe any gender differences in their studies. The predominance of CM in a given gender has resulted in many studies with controversial results.…”

“…For example, the median in the study performed by Kamiji and Oliveira 20 was 67 years, and the study conducted by Meneghelli et al 23 revealed that a median of 55 years. Thus, the prevalence of older patients (> 40 years old) with CM deserves special attention, not only with regard to esophagopathy but also other comorbidities that are prevalent in the population in this age group, such as cardiovascular and metabolic diseases 19 .…”

Results of the surgical treatment of non-advanced megaesophagus using Heller–Pinotti's surgery: Laparotomy vs. Laparoscopy

“…Chagasic megaesophagus corresponds to at least 80% of cases submitted to surgical treatment in Brazil,16,22,23 unlike countries in the developed world where cases consist almost entirely of idiopathic achalasia24 and affect 1 in every 100,000 individuals 25. …”