Key Points

• Chagas disease is caused by the protozoan hemoflagellate Trypanosoma Cruzi usually transmitted by a vector-borne insect (triatomine bug) that carries the parasite.
• Approximately 30% of chronically infected hosts develop cardiac disease (Chagas cardiomyopathy) whereas 10% develop digestive, neurological or mixed clinical alterations requiring treatment.
• Achalasia and megaesophagus are the esophageal manifestation of the disease and both derive from the destruction of Meissner and Auerbach plexuses of the esophagus by the parasite.
• Chagas’ esophageal achalasia shares the same clinical features of idiopathic achalasia such as disabling dysphagia and regurgitation resulting from the motor dysfunction of the lower esophagus and the subsequent development of megaesophagus.
• Diagnosis is done by clinical the signs and symptoms, barium swallow, esophageal motility study and upper gastrointestinal endoscopy.
• Non-surgical management of Chagas disease esophagopathy includes medical treatment with prokinetic drugs, hydrostatic baloon dilatation, botulin toxin injection in the lower esophagus and peroral endoscopic myotomy .
• Surgical treatment of Chagasic esophageal achalasia is focused on restoring the swallowing function either by cardiomyotomy with or without fundoplication, or by esophagectomy with stomach interposition depending on the degree of the megaesophagus. Colon interposition is to be avoided due to the frequent association between Chagas achalasia and megacolon.