title: Clinical, radiographic, and manometric evolution of esophageal involvement by Chagas' disease.
abstract: The complete manifestation of esophageal Chagas' disease includes nonperistaltic contractions in the esophageal body, absent lower esophageal sphincter (LES) relaxation, and dilatation of the organ. However, some patients have a minor degree of esophageal denervation and esophageal motility that does not imply a diagnosis of achalasia. Our objective was to evaluate the evolution of esophageal involvement by Chagas' disease in 28 patients with dysphagia for solids and liquids and a positive serologic test for the disease, 14 with complete LES relaxation, 4 with partial (incomplete) LES relaxation, and 10 with absent LES relaxation; only 2 of them had mild dilatation. The patients (21 women), aged 43-74 years (median 60 years), were evaluated by clinical, radiographic, and manometric methods that were repeated 3-14 years (median 7 years) later. Dysphagia improved in 13 (46.4%) patients, was worse in 5 (17.9%), and did not change in 10 (35.7%). The radiographic examination did not change in 24 (85.7%) and was worse in 3 (10.7%). Esophageal manometry revealed a change from peristaltic to simultaneous contractions in 2 patients (7.1%), LES relaxation changed from complete to partial in 5 (17.9%), and from partial to absent in 2 (7.1%). There was no further clinical, radiographic, or manometric impairment in 15 (53.6%) patients. The symptom duration was longer and the age when they were evaluated was older in patients with no progression of the disease. We conclude that a conspicuous part of this group of patients with esophageal Chagas' disease and dysphagia had no progression of esophageal disease after 3-14 years. This possibility should be considered when making therapeutic decisions.
authors.affiliation: Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Ribeirão Preto, Brazil.
authors.forename: Ulysses G
authors.initials: UG
authors.lastname: Meneghelli
authors.forename: Fernanda M
authors.initials: FM
authors.lastname: Peria
authors.forename: Fabiana M R
authors.initials: FM
authors.lastname: Darezzo
authors.forename: Fernando H
authors.initials: FH
authors.lastname: Almeida
authors.forename: Carla M
authors.initials: CM
authors.lastname: Rodrigues
authors.forename: Lilian R O
authors.initials: LR
authors.lastname: Aprile
authors.forename: Roberto O
authors.initials: RO
authors.lastname: Dantas
mesh_terms: D000328:Adult; D000368:Aged; D014355:Chagas Disease / Q000175:diagnosis / Q000503:physiopathology*; D018450:Disease Progression; D015154:Esophageal Motility Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D049630:Esophageal Sphincter, Lower / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D009126:Muscle Relaxation / Q000502:physiology; D010528:Peristalsis / Q000502:physiology; D011446:Prospective Studies; D011859:Radiography