Page 126 - Read Online

Dantas Idiopathic and chagasic achalasia

CLINICAL PRESENTATION AND TREATMENT Ethics approval
Not applicable.
Despite differences in pathophysiology of Chagas’
disease-related and idiophatic achalasia, the clinical REFERENCES
presentation in both diseases is the same, with
dysphagia as a common complaint, affecting more 1. Jeon HH, Kim JH, Youn YH, Park H, Conklin JL. Clinical
than 90% of the patients. However, the symptoms characteristics of patients with untreat achalasia. J Neurogastroenterol
occurs later in patients with Chagas’ disease achalasia, Motil 2017;23:370-7.
a long time after the infection, and may be associated 2. Pressman A, Behar J. Etiology and pathogenesis of idiopathic
with aging-related changes in esophageal motility [10] in 3. achalasia. J Clin Gastroenterol 2017;51:1195-201.
Crespin OM, Tatum RP, Xiao K, Martin AV, Khandelwal S, Pellegrini
addition to impairment of esophageal myenteric plexus CA, Oelschlager BK. The relationship between manometric subtype
caused by the disease. In the evaluation of the water and outcomes of surgical treatments for patients with achalasia. Surg
ingestion dynamics patients with dysphagia caused Endosc 2017; doi: 10.1007/s00464-017-5570-5.
by Chagas’ disease or idiopathic achalasia have the 4. Pandolfino JE, Kahrilas PJ. Presentation, diagnosis, and management
same behavior [27] . of achalasia. Clin Gastroenterol Hepatol 2013;11:887-97.
5. Oliveira RB, Troncon LEA, Dantas RO, Meneghelli UG.
Taken together, both Chagas’ disease-related Gastrointestinal manifestations of Chagas’ disease. Am J Gastroenterol
1998;93:884-9.
and idiopathic achalasia have similar clinical and 6. Matsuda NM, Miller SM, Évora PRB. The chronic gastrointestinal
radiologic manifestations, including nonrelaxing or manifestations of Chagas’ disease. Clinics 2009;64:1219-24.
partially relaxing lower esophageal sphincter and 7. Bern C, Montgomery SP, Herwaldt BL, Rassi Jr A, Marin-Neto
esophageal aperistalsis, although the pathophysiology JA, Dantas RO, Magure JH, Acquatella H, Morillo C, Kirchhoff
of the diseases should not be the same. Therefore, LV, Gilman RH, Reyes PA, Salvatella R, Moore AC. Evaluation of
treatment of both conditions is similar, and include treatment of Chagas’ disease in the United States. A systematic review.
pneumatic dilation of the esophageal-gastric transition, 8. JAMA 2007;298:2171-81.
Sánches-Montalvá A, Moris M, Mego M, Salvador F, Accarino A,
laparoscopic Heller myotomy and, the more recent Ramirez K, Azpiroz F, Ruiz de Leon A, Molina I. High resolution
peroral endoscopic myotomy (POEM) [28-30] . Drugs esophageal manometry in patients with Chagas’ disease: a cross-
and botulinum toxin may be used in special cases [31] sectional evaluation. PLoS Negl Trop Dis 2016;10:e0004416.
and esophagectomy for advanced cases. There is no 9. Bern C. Chagas’ disease. N Engl J Med 2015;373:456-66.
cure for the disease, and the objective of treatment is 10. Köberle F. Chagas’ disease and Chagas’ syndromes: the pathology of
relieve the symptoms and permit an adequate food American trypanosomiais. Adv Parasitol 1968;6:63-116.
ingestion [31] . Drugs cause benefit for a short time and 11. Dantas RO. Idiopathic achalasia and chagasic megaesophagus. J Clin
Gastroenterol 1988;10:13-5.
have side effects which may be intense. The remission 12. Dantas RO. Comparison between idiopathic achalasia and achalasia
of the symptoms with pneumatic dilatation may least caused by Chagas’ disease: a review about the pathophysiology of the
for 5 to 10 years, but the most effective treatment diseases. Arq Gastroenterol 2003;40:126-30. (in Portuguese)
is laparoscopic or endoscopic myotomy, with an 13. Herbella FAM, Oliveira DRFC, Del Grande JC. Are idiopathic and
improvement of the symptoms for 6 to 10 years [31] . chagasic achalasia two different diseases? Dig Dis Sci 2004;49:353-
The patients who have a better response to treatment, 60.
pneumatic dilation or Heller myotomy, are them who 14. Cohen S, Lipshutz W, Hughes W. Role of gastrin supersensitivity in
the pathogenesis of the lower esophageal sphincter hypertension in
has isobaric panesophageal pressurization after achalasia. J Clin Invest 1971;50:1241-7.
swallowing. 15. Holloway RH, Dodds WJ, Helm JF, Hogan WJ, Dent J, Arndorfer RC.
Integrity of cholinergic innervations to the lower esophageal sphincter
DECLARATIONS in achalasia. Gastroenterology 1986;90:924-9.
16. Dantas RO, Godoy RA, Oliveira RB, Meneghelli UG, Troncon LEA.
Authors’ contributions Lower esophageal sphincter pressure in Chagas’ disease. Dig Dis Sci
1990;35:508-12.
R.O. Dantas contributed solely to the paper. 17. Lemme EMO, Domingues GR, Pereira VLC, Firman CG, Pantoja
J. Lower esophageal sphincter pressure in idiopathic achalasia and
Financial support and sponsorship Chagas’ disease-related achalasia. Dis Esophagus 2001;14:232-4.
None. 18. Padovan W, Godoy RA, Dantas RO, Meneghelli UG, Oliveira RB,
Troncon LEA. Lower oesophageal sphincter response to pentagastrin
in chagasic patients with megaesophagus and megacolon. Gut
Conflicts of interest 1980;21:85-90.
There are no conflicts of interest. 19. Dantas RO, Deghaide NHS, Donadi EA. Esophageal motility of
patients with Chagas’ disease and idiopathic achalasia. Dig Dis Sci
2001;46:1200-6.
Patient consent 20. Hirano I. Pathophysiology of achalasia. Curr Gastroenterol Rep
Not applicable. 1999;1:198-202.
Mini-invasive Surgery ¦ Volume 1 ¦ September 30 119