High Resolution Esophageal Manometry in Patients with Chagas Disease : A Cross-Sectional Evaluation
Sánchez-Montalvá, Adrián (Hospital Universitari Vall d'Hebron)
Moris, Maria (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Mego Silva, Marianela (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Salvador, Fernando (Hospital Universitari Vall d'Hebron)
Accarino, Ana María (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Ramírez, Kathleen (Hospital Universitari Vall d'Hebron)
Azpiroz Vidaur, Fernando (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Ruiz-de-Leon, Antonio (Universidad Complutense de Madrid)
Molina Romero, Israel (Hospital Universitari Vall d'Hebron)
Universitat Autònoma de Barcelona. Departament de Medicina

Data:	2016
Resum:	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. 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. 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. 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. Chagas disease is a parasitic disease mainly transmitted to humans by blood-sucking insects. The disease was endemic in Latin America, but it is now a global disease due to migratory movements. The disease can affect the heart and the digestive system (mainly esophagus and colon). Classically, esophageal assessment in Chagas disease is performed by X-ray and self-reported symptoms. However, they lack accuracy and detect only advanced stage of the disease. Recently, new tools, such as esophageal high resolution manometry, provide more detailed information about the motility disorders of the esophagus. We assessed the esophageal involvement in patients with Chagas disease by means of high resolution manometry and compared the findings with the X-ray and self-reported symptoms. We found a low rate of mild severity motility disorders. We did not find an association between X-ray assessment and symptoms with the high resolution manometry findings. The assessment of esophageal involvement in patients with Chagas disease may benefit from early diagnosis by high resolution manometry, although more research is needed.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	PLoS neglected tropical diseases, Vol. 10 (february 2016) , ISSN 1935-2735

DOI: 10.1371/journal.pntd.0004416
PMID: 26848957

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