title: High Resolution Esophageal Manometry in Patients with Chagas Disease: A Cross-Sectional Evaluation.
abstract: BACKGROUND
  Gastrointestinal involvement affects 30-40% of the patients with chronic Chagas disease. Esophageal symptoms appear once the structural damage is established. Little is known about the usefulness of high resolution manometry to early identification of esophageal involvement.
  
  
  METHODS
  We performed a cross-sectional study at the Vall d'Hebron University Hospital (Barcelona, Spain) between May 2011 and April 2012. Consecutive patients diagnosed with Chagas disease in the chronic phase were offered to participate. All patients underwent a structured questionnaire about digestive symptoms, a barium esophagogram (Rezende classification) and an esophageal high resolution manometry (HRM). A control group of patients with heartburn who underwent an esophageal HRM in our hospital was selected.
  
  
  RESULTS
  62 out of 73 patients that were included in the study fulfilled the study protocol. The median age of the Chagas disease group (CG) was 37 (IQR 32-45) years, and 42 (67.7%) patients were female. Twenty-seven (43.5%) patients had esophageal symptoms, heartburn being the most frequent. Esophagogram was abnormal in 5 (8.77%). The esophageal HRM in the CG showed a pathological motility pattern in 14 patients (22.6%). All of them had minor disorders of the peristalsis (13 with ineffective esophageal motility and 1 with fragmented peristalsis). Hypotonic lower esophageal sphincter was found more frequently in the CG than in the control group (21% vs 3.3%; p<0.01). Upper esophageal sphincter was hypertonic in 22 (35.5%) and hypotonic in 1 patient. When comparing specific manometric parameters or patterns in the CG according to the presence of symptoms or esophagogram no statistically significant association were seen, except for distal latency.
  
  
  CONCLUSIONS
  The esophageal involvement measured by HRM in patients with chronic Chagas disease in our cohort is 22.6%. All the patients with esophageal alterations had minor disorders of the peristalsis. Symptoms and esophagogram results did not correlate with the HRM results.
authors: Infectious Diseases Department, Tropical Medicine Unit, PROSICS (International Health Program of the Catalan Health Institute), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: Adrián
authors: A
authors: Sánchez-Montalvá
authors: Digestive System Research Unit, Vall d'Hebron University Hospital, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: María
authors: M
authors: Moris
authors: Digestive System Research Unit, Vall d'Hebron University Hospital, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: Marianela
authors: M
authors: Mego
authors: Infectious Diseases Department, Tropical Medicine Unit, PROSICS (International Health Program of the Catalan Health Institute), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: Fernando
authors: F
authors: Salvador
authors: Digestive System Research Unit, Vall d'Hebron University Hospital, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: Anna
authors: A
authors: Accarino
authors: Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain.
authors: Kathleen
authors: K
authors: Ramírez
authors: Digestive System Research Unit, Vall d'Hebron University Hospital, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: Fernando
authors: F
authors: Azpiroz
authors: Department of Gastroenterology, University Hospital San Carlos, Universidad Complutense, Madrid, Spain.
authors: Antonio
authors: A
authors: Ruiz-de-Leon
authors: Infectious Diseases Department, Tropical Medicine Unit, PROSICS (International Health Program of the Catalan Health Institute), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: Israel
authors: I
authors: Molina
mesh_terms: D000328:Adult; D014355:Chagas Disease / Q000175:diagnosis*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004947:Esophagus / Q000737:chemistry*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D013030:Spain