title: Characterization of digestive involvement in patients with chronic T. cruzi infection in Barcelona, Spain.
abstract: BACKGROUND
  Digestive damage due to Chagas disease (CD) occurs in 15-20% of patients diagnosed as a result of peristaltic dysfunction in some endemic areas. The symptoms of chronic digestive CD are non-specific, and there are numerous confounders. Diagnosis of CD may easily be missed if symptoms are not evaluated by a well trained physician. Regular tests, as barium contrast examinations, probably lack the necessary sensitivity to detect early digestive damage.
  
  
  METHODS
  71 individuals with T. cruzi infection (G1) and 18 without (G2) coming from Latin American countries were analyzed. They were asked for clinical and epidemiological data, changes in dietary habits, and history targeting digestive and cardiac CD symptoms. Serological tests for T. cruzi, barium swallow, barium enema, an urea breath test, and esophageal manometry were requested for all patients.
  
  
  RESULTS
  G1 and G2 patients did not show differences in lifestyle and past history. Fifteen (21.1%) of G1 had digestive involvement. Following Rezende criteria, esophagopathy was observed in 8 patients in G1 (11.3%) and in none of those in G2. Manometry disorders were recorded in 34 G1 patients and in six in G2. Isolated hypotensive lower esophageal sphincter (LES) was found in sixteen G1 patients (23.9%) and four G2 patients (28.8%). Achalasia was observed in two G1 patients. Among G1 patients, ineffective esophageal motility was seen in six (five with symptoms), diffuse esophageal spasm in two (one with dysphagia and regurgitation), and nutcracker esophagus in three (all with symptoms). There were six patients with hypertonic upper esophageal sphincter (UES) among G1. Following Ximenes criteria, megacolon was found in ten G1 patients (13.9%), and in none of the G2 patients.
  
  
  CONCLUSIONS
  The prevalence of digestive chronic CD in our series was 21.1%. Dysphagia is a non-pathognomonic symptom of CD, but a good marker of early esophageal involvement. Manometry could be a useful diagnostic test in selected cases, mainly in patients with T. cruzi infection and dysphagia in whose situation barium swallow does not evidence alterations. Constipation is a common but non-specific symptom that can be easily managed. Testing for CD is mandatory in a patient from Latin America with constipation or dysphagia, and if diagnosis is confirmed, megacolon and esophageal involvement should be investigated.
authors.affiliation: Barcelona Centre for International Health Research (CRESIB), Hospital Clínic i Provincial/IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
authors.forename: María-Jesús
authors.initials: MJ
authors.lastname: Pinazo
authors.affiliation: Gastrointestinal Motility Unit, Gastroenterology Department, Hospital Clinic, Barcelona, Spain.
authors.forename: Gloria
authors.initials: G
authors.lastname: Lacima
authors.affiliation: Gastroenterology Department, Hospital Clínic, Barcelona, Spain.
authors.forename: José-Ignacio
authors.initials: JI
authors.lastname: Elizalde
authors.affiliation: Barcelona Centre for International Health Research (CRESIB), Hospital Clínic i Provincial/IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Elizabeth-Jesús
authors.initials: EJ
authors.lastname: Posada
authors.affiliation: Radiology Department, CDIC, Hospital Clínic, Barcelona, Spain.
authors.forename: Fausto
authors.initials: F
authors.lastname: Gimeno
authors.affiliation: Barcelona Centre for International Health Research (CRESIB), Hospital Clínic i Provincial/IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Edelweiss
authors.initials: E
authors.lastname: Aldasoro
authors.affiliation: Microbiology Department, Hospital Clínic, Barcelona, Spain.
authors.forename: María-Eugenia
authors.initials: ME
authors.lastname: Valls
authors.affiliation: Barcelona Centre for International Health Research (CRESIB), Hospital Clínic i Provincial/IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Gascon
mesh_terms: D000328:Adult; D014355:Chagas Disease / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D002908:Chronic Disease; D004935:Esophageal Diseases / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013030:Spain / Q000453:epidemiology