Chagas Disease Esophagopathy
- 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.
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Last updated: October 18, 2022
Guerreiro Cardoso, Paulo F, et al. "Chagas Disease Esophagopathy." Pearson's General Thoracic Surgery. STS Cardiothoracic Surgery E-Book, Chicago: Society of Thoracic Surgeons, 2022. STS Surgery, ebook.sts.org.
Guerreiro Cardoso PF, Nasi A, Bianchi ET, Salum R, Cecconello I. Chagas Disease Esophagopathy. In: Darling GE, Baumgartner WA, Jacobs JP, eds. Pearson's General Thoracic Surgery. STS Cardiothoracic Surgery E-Book. Chicago: Society of Thoracic Surgeons; 2022. ebook.sts.org. Accessed November 28, 2023.
Guerreiro Cardoso, P. F., Nasi, A., Bianchi, E. T., Salum, R., & Cecconello, I. (2022). Chagas Disease Esophagopathy. In Darling, G., Baumgartner, W., & Jacobs, J. (Eds.), Pearson's General Thoracic Surgery. STS Cardiothoracic Surgery E-Book. Chicago: Society of Thoracic Surgeons. ebook.sts.org
Guerreiro Cardoso PF, Nasi A, Bianchi ET, Salum R, Cecconello I. Chagas Disease Esophagopathy [Internet]. In: Darling GE, Baumgartner WA, Jacobs JP, editors. Pearson's General Thoracic Surgery. STS Cardiothoracic Surgery E-Book. Chicago: Society of Thoracic Surgeons; 2022. [cited 2023 November 28]. Available from: ebook.sts.org.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Chagas Disease Esophagopathy ID - 1418576 ED - Jacobs,J, ED - Darling,Gail, ED - Baumgartner,William, Y1 - 2022/10/18/ BT - Pearson's General Thoracic UR - https://ebook.sts.org/sts/view/Pearsons-General-Thoracic/1418576/0/Chagas_Disease_Esophagopathy PB - Chicago: Society of Thoracic Surgeons DB - STS Surgery DP - Unbound Medicine ER -