Hipocontratilidade do esôfago em pacientes com doença de chagas e pacientes com acalásia idiopática
ABSTRACT Em pacientes com esofagopatia chagásica e pacientes com acalásia, a amplitude das contrações esofágicas está diminuída. Como nem todas as deglutições são seguidas de contrações com baixa amplitude, avaliamos o número de contrações com amplitude abaixo de 30 mm Hg em 40 voluntários assintomáticos, 99 pacientes com doença de Chagas e 14 pacientes com acalásia idiopática. Cada paciente ou voluntário realizou 10 deglutições de 5 mL de água e o registro das contrações foi feito a 5 cm, 10 cm e 15 cm proximal ao esfíncter inferior do esôfago. Neste registro foi utilizado o método manométrico com perfusão contínua. O número de contrações com hipocontratilidade foi maior nos pacientes com doença de Chagas e pacientes com acalásia do que nos voluntários (P <0,05). Pacientes chagásicos com trânsito lento no exame radiológico mas sem dilatação do esôfago tiveram mais contrações com baixa amplitude do que pacientes com exame radiológico normal (P <0,01). O mesmo resultado se obteve quando da análise do número de indivíduos com três ou mais contrações com baixa amplitude (P <0,01). Os pacientes chagásicos com disfagia tiveram mais contrações com hipocontratilidade do que aqueles sem disfagia (P <0,05). Concluímos que na doença de Chagas e na acalásia idiopática ocorre maior número de contrações esofágicas com baixa amplitude do que em pessoas normais, o que deve contribuir para a sintomatologia dos pacientes.
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ABSTRACT: This study analyzed the radiologic and manometric findings of 43 patients suffering from chagasic megaesophagus with positive tests for Chagas' disease. There was a significant reduction in the high pressure levels of the body of the esophagus related to the stage of the disease: stage I/II - 42.9 mmHg; stage III - 23.6 mmHg; stage IV - 15.6 mmHg. It was observed that 5 (35.7%) stage III patients had high pressure levels below 20 mmHg and presented advanced megaesophagus and these underwent a subtotal esophagectomy following esophagogastroplasty instead of cardiomyotomy with anti-reflux valve. The manometric study in stage III patients with chagasic megaesophagus was considered helpful to indicate which surgical procedure would be best for these patients.
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ABSTRACT: BACKGROUND: Although idiopathic achalasia and achalasia caused by Chagas' disease have the same clinical manifestations and treatment, both with destruction of the esophageal myenteric plexus, it is possible that there are differences in the alterations of esophageal motility between the two diseases, caused by different grades of impairment of the excitatory and inhibitory esophageal neurons. AIMS: We performed a review of papers with results about the pathophysiology and esophageal motility alterations in idiopathic achalasia and Chagas' disease. DATE SOUCERS: We reviewed papers which included data about the characteristics of idiopathic achalasia and Chagas' disease. DATA SYNTHESIS: Impairment of inhibitory esophageal neurons was shown in the two diseases. The results of the studies of the effects of atropine, edrophonium and botulin toxin suggested that the excitatory innervation is more intensely impaired in Chagas' disease than in idiopathic achalasia, explaining the increase in the lower esophageal sphincter pressure found in achalasia. The patients with Chagas' disease have more circulating muscarinic cholinergic receptor M2 autoantibodies than patient with idiopathic achalasia. The duration of the contractions in the esophageal body is longer in idiophatic achalasia than in Chagas' disease. CONCLUSIONS: The papers that studied Chagas' disease and idiopathic achalasia, mainly those which studied both diseases with the same methods, suggested that there are different grades of esophageal involvement by the two diseases, mainly the most important involvement of excitatory innervation in Chagas' disease than in idiopathic achalasia.Arquivos de Gastroenterologia 06/2003; 40(2):126-130.
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ABSTRACT: Previous studies have correlated esophageal body motility findings in idiopathic (IdAc) achalasia and achalasia secondary to Chagas' disease (ChAc) with degree of megaesophagus. The aim of this study was to compare esophageal body manometric data in patients with IdAc and achalasia secondary to Chagas' disease and correlate it with the degree of megaesophagus and symptom duration. One hundred nontreated patients with achalasia, 79% IdAc and 21% secondary to ChAc were compared with regards to age of presentation, duration of symptoms, amplitude and duration of simultaneous contractions, frequency of failed contractions, and degree of megaesophagus. Seventy-one percent of patients were classified as nonadvanced megaesophagus (60 [76%] with IdAc and 11 [52%] with ChAc) and 29% as advanced megaesophagus (19 [24%] with IdAc and 10 [48%] with ChAc, P= 0.04). In IdAc but not in ChAc, the symptom duration was significantly longer in advanced megaesophagus (A) compared with nonadvanced megaesophagus (NA) (34.8 ± 6.3 months vs. 95.4 ± 22.2 months, P= 0.001). There was no difference in amplitude and duration of simultaneous contractions in both achalasia groups (P > 0.05). Duration of contractions were longer in IdAc compared with ChAc in (NA) (P < 0.05), but not in (A). In IdAc but not in ChAc the amplitude of simultaneous contractions decreased with increased esophageal dilatation (P < 0.05). In ChAc but not in IdAC, the duration of contractions increased with esophageal dilatation (P < 0.05). Failed contractions were more frequent in ChAc group (28.6%) than in IdAc (10% -P= 0.03). Patients with ChAc have a higher prevalence of advanced megaesophagus compared with IdAc at diagnosis. In IdAc there was a strong correlation between advanced megaesophagus and longer symptom duration, suggesting disease progression over time, not observed in ChAc in which a more extensive denervation occurs earlier in the disease process.Diseases of the Esophagus 12/2010; 24(5). DOI:10.1111/j.1442-2050.2010.01142.x · 2.06 Impact Factor