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Dantas. Mini-invasive Surg 2017;1:117-20 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2017.25
www.misjournal.net
Topic: Achalasia Management: the South American viewpoint Open Access

Differences between idiopathic and chagasic

achalasia

Roberto Oliveira Dantas
Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto SP 14049-900, Brazil.

Correspondence to: Dr. Roberto Oliveira Dantas, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Av Bandeirantes 3900,
Ribeirão Preto SP 14049-900, Brazil. E-mail: rodantas@fmrp.usp.br

How to cite this article: Dantas RO. Differences between idiopathic and chagasic achalasia. Mini-invasive Surg 2017;1:117-20.

Dr. Roberto Oliveira Dantas, is a Senior Associate Professor at the Department of Medicine, Division of
Gastroenterology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil. He is a
Member of the Advisory Board of the journal Gastroenterology and the Editorial Advisory Board of the journal
Dysphagia. In addition, he is also a member of the Board of Directors of the International Dysphagia Diet
Standardisation Initiative (IDDSI).

ABSTRACT
Article history: Idiopathic and Chagas’ disease achalasia are characterized by absent or partial lower esophageal
Received: 11 Jul 2017 sphincter relaxation, absence of peristaltic esophageal contraction, food retenction in the
Accepted: 3 Aug 2017 esophagus and esophageal dilatation. The most frequent symptoms are dysphagia, regurgitation,
Published: 30 Sep 2017 heartburn, weight loss and non-cardiac chest pain. The diagnosis is made by radiologic
examination and esophageal manometry, which is considered the most accurate exam to
Key words: characterized achalasia. In both diseases there is destruction of the esophageal myenteric plexus.
Achalasia, Despite similarities in clinical and manometric presentation there is evidence of greater loss of
Chagas’ disease, inhibitory neurons of the myenteric plexus in idiopathic achalasia, whereas in Chagas’ disease
megaesophagus, there is a loss of both excitatory and inhibitory neurons. Such differences, though do not affect
dysphagia, patients’ clinical presentation, and hence treatment options should be the same for both diseases.
esophageal denervation

INTRODUCTION regurgitation, heartburn, weight loss and non-cardiac
chest pain . The diagnosis is made by radiologic
[1]
Achalasia is a disease characterized by absent or examination of the esophagus and esophageal
partial relaxation of the lower esophageal sphincter, manometry, which is the most accurate exam to
absence of peristaltic esophageal contraction, food characterized achalasia. In this test, achalasia is
retention and esophageal dilation [1,2] . characterized by increased integrated relaxation
pressure of the lower esophageal sphincter and
The most common symptoms are dysphagia, absence of peristaltic contraction in the esophageal

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