Radiological findings in megaesophagus secondary to Chagas disease: chest X-ray and esophagogram

Abstract

ObjectiveTo identify and classify the radiographic patterns of megaesophagus in Chagas disease, as seen on esophagograms and chest X-rays.Materials and MethodsThis was a prospective study of 35 patients diagnosed with esophageal disease via manometry. The changes found on esophagograms were stratified according to Rezende's classification, divided into four categories (grades I through IV) determined by the degree of dilatation and impairement of esophageal motility. We subsequently correlated that ranking with the chest X-ray findings: gastric air bubble; air-fluid level; and mediastinal widening.ResultsAmong the 35 patients, the esophageal disease was classified as grade I in 9 (25.7%), grade II in 3 (8.6%), grade III in 19 (54.3%), and grade IV in 4 (11.4%). None of the patients with grade I esophageal disease showed changes on chest X-rays. In two of the three patients with grade II disease, there was no gastric air-bubble, although there were no other findings in any of the grade II patients. Of the 19 patients with grade III disease, 15 had abnormal findings on X-rays. All four patients with grade IV disease showed abnormalities.ConclusionThe use of Rezende's classification is feasible, encompassing findings ranging from the subtle changes that characterize the initial phases of esophageal disease to the complete akinesia seen in dolicomegaesophagus. Chest X-ray findings are more common in patients with advanced stages of the disease and indicate the degree of esophageal involvement in Chagas disease.

Cross-Sectional Study of Swallowing Phases in Cases of Megaesophagus Caused by Chagas Disease

“…There were a greater number of women assessed, which may have influenced the results - although this is still an unconfirmed possibility. Esophageal manometric examination was not performed; however, this examination is not essential to demonstrate the esophageal involvement by Chagas disease [ 14 ].…”

“…Chagasic esophagopathy was diagnosed with radiological examination of the esophagus, using abnormality criteria based on the megaesophagus classification described in 1960 [ 13 , 14 ] and standard distances and volume of barium sulfate ingested, performed after 12 h of fasting. In this classification, the degree I refers to patients with slow transit and retention of contrast medium in the esophageal body, without an increase in the distal diameter.…”

Symptoms Associated With Different Degrees of Megaesophagus in Chagas Disease

“…Radiological examinations of the esophagus were conducted to classify megaesophagus into four degrees based on the technique described in 1960 (11) , in which degree I is the least impaired and degree IV, the most impaired (11)(12)(13) . The descriptions of these degrees are in reference (13) .The diagnosis of esophageal involvement by Chagas' disease was done by the radiologic examination.…”

Treatment challenges of sigmoid-shaped esophagus and severe achalasia

“…However, peri-operative respiratory symptoms including chronic/nocturnal cough, dyspnea and acute respiratory symptoms like choking spells and asphyxia are occasionally encountered. The structural alterations of the esophagus become irreversible in end-stage sigmoid esophagus and treatments such as mechanical pneumatic dilation, botulinum toxin injections, and myotomy are rendered less effective in the long term, often leading to need for re-treatment [ 33 ].…”