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Duodenogastric reflux in chagas' disease

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Abstract

Increased duodenogastric reflux has been recognized as a cause of gastric mucosa damage. The frequent finding of bile-stained gastric juice and a suggested higher frequency of lesions of the gastric mucosa in patients with Chagas' disease, which is characterized by a marked reduction of myenteric neurons, suggest that impairment of intrinsic innervation of the gut might be associated with increased duodenogastric reflux. Duodenogastric bile reflux was quantified after intravenous injection of99mtechnetium-HIDA, in 18 patients with chronic Chagas' disease, 12 controls, and 7 patients with Billroth II gastrectomy. All but one of the chagasic patients were submitted to upper digestive tract endoscopy. High reflux values (⩾10%) were detected both in chagasic patients and in the controls, but the values for both groups were significantly lower (P< 0.01) than those obtained for Billroth II patients (median: 55.79%; range: 12.58– 87.22%). Reflux values tended to be higher in the Chagas' disease group (median: 8.20%; range: 0.0– 29.40%) than in the control group (median: 3.20%; range: 0.0– 30.64%), with no statistical difference between the two groups (P>0.10). Chronic gastritis was detected by endoscopy in 12 chagasic patients, benign gastric ulcer in 2 patients, and a pool of bile in the stomach in 11 patients. However, neither the occurrence of gastric lesions nor the finding of bile-stained gastric juice was associated with high reflux values after [99mTc]HIDA injection. This study suggests that lesions of the intramural nervous system of the gut in Chagas' disease do not appear to be associated with abnormally increased duodenogastric reflux.

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References

  1. Heading RC: Duodenogastric reflux. Gut 24:507–509, 1983

    PubMed  Google Scholar 

  2. Niemela S: Duodenogastric reflux in patients with upper abdominal complaints or gastric ulcer with particular reference to reflux-associated gastritis. Scand J Gastroenterol 20(Suppl 115):1–56, 1985

    PubMed  Google Scholar 

  3. Nath BJ, Warshaw AL: Alkaline reflux gastritis and esophagitis. Annu Rev Med 35:383–396, 1984

    PubMed  Google Scholar 

  4. Rhodes J, Barnardo DE, Phillips SF, Rovelstad RA, Hoffman AF: Increased reflux of bile into the stomach in patients with gastric ulcer. Gastroenterology 57:241–252, 1969

    PubMed  Google Scholar 

  5. Sonnenberg A, Müller-Lissner SA, Schatlenman G, Siewert JR, Blum AL: Duodenogastric reflux in the dog. Am J Physiol 242:G603-G607, 1982

    PubMed  Google Scholar 

  6. Müller-Lissner SA, Fimmel CJ, Sonnenberg A, Will N, Müller-Duysing W, Heinzel F, Blum AL: A novel approach to quantify duodenogastric reflux in healthy volunteers and in patients with type I gastric ulcer. Gut 24:510–518, 1983

    PubMed  Google Scholar 

  7. Köberle F: Chagas' disease and Chagas' syndromes. Adv Parasital 6:63–116, 1968

    Google Scholar 

  8. Oliveira RB, Troncon LEA, Meneghelli UG, Padovan W, Dantas RO, Godoy RA: Impaired gastric accommodation to distension and rapid gastric emptying in patients with Chagas' disease. Dig Dis Sci 25:790–794, 1980

    PubMed  Google Scholar 

  9. Lopasso FP, Pinto PE Jr, Gama-Rodrigues JJ, Pinotti HW: Estudo do esvaziamento gástrico de partículas sólidas e digeríveis marcadas com99mTc na gastropatia chagásica crÔnica. Gastroenterol Endosc Dig 4:72–76, 1985

    Google Scholar 

  10. Oliveira RB, Meneghelli UG, Godoy RA, Dantas RO, Padovan W: Abnormalities of interdigestive motility of the small intestine in patients with Chagas' disease. Dig Dis Sci 28:294–299, 1983

    PubMed  Google Scholar 

  11. Ceneviva R, Módena JLP, Castelfranchi PL: DoenÇa de Chagas e Úlcera gástrica. Arq Gastroenterol SÃo Paulo 8:85–88, 1971

    Google Scholar 

  12. Rezende JM, Rosa H, Vaz MGM, Andrade-Sá N, Porto JD, Neves Neto J, Ximenez JAA: Endoscopia no megaesÔfago: estudo prospectivo de 600 casos. Arq Gastroenterol SÃo Paulo 22:53–62, 1985

    Google Scholar 

  13. Camargo ME: Fluorescent antibody test for the serum diagnosis of American trypanosomiasis. Technical modification employing preserved culture forms ofTrypanosoma cruzi on a slide test. Rev Inst Med Trop SÃo Paulo 8:227–234, 1966

    Google Scholar 

  14. Bettarello A and Pinotti HW: Oesophageal involvement in Chagas' disease. Clin Gastroenterol 5:103–117, 1976

    Google Scholar 

  15. Nicolai JJ, Silberbusch J, Van Roon F, Schopman W, vd Berg JWO: A simple method for the quantification of biliary reflux. Scand J Gastroenterol 15:775–780, 1980

    PubMed  Google Scholar 

  16. Siegel S: Nonparametric Statistics for the Behavioral Sciences. Tokyo, McGraw-Hill, 1959

    Google Scholar 

  17. Glikmanas M, Sovillac P, Monteiro I, Gatineau-Saillant G: La constatation d'un lac bilieux en endoscopie: a t'elle une signification physiopathologique? ètude en pH gastrique pendant 24 heures. Gastroenterol Clin Biol 8:796–799, 1984

    PubMed  Google Scholar 

  18. Eyre-Brook IA, Holroyd AN, Johnson AG: Is bile reflux at endoscopy a significant finding? Scand J Gastroenterol 19(Suppl 92):203–205, 1984

    Google Scholar 

  19. Fisher R: Pyloric sphincter dysfunction and the consequences of enterogastric reflux disease.In Esophageal and Gastric Emptying. A Dubois, DO Castell (eds),. Boca Raton, Florida, C.R.C. Press, 1984, pp 129–146

    Google Scholar 

  20. Troncon LEA, Silva OC, Zucoloto S, Ferriolli Filho F, Meneghelli UG: Susceptibilidade da mucosa gástrica á acÃo lesiva de um sal biliar em ratos chagásicos crÔnicos. Rev Soc Bras Med Trop (submitted)

  21. Rezende JM: ManifestaÇÕes digestivas da doenÇa de Chagas.In Gastroenterologia Clínica. R Dani, L Paula Castro (eds). Rio de Janeiro, Guanabara-Koogan, 1981, pp 1141–1168

    Google Scholar 

  22. Redo SF, Barnes WA, De La Sienna AO: Perfusion of the canine oesophagus with secretions of the upper gastrointestinal tract. Ann Surg 149:556–564, 1959

    PubMed  Google Scholar 

  23. Gillison EW, De Castro UAM, Nyhus LM, Kusakari I, Bombeck CT: The significance of bile in reflux oesophagitis. Surg Gynecol Obstet 134:419–424, 1972

    PubMed  Google Scholar 

  24. Keane FB, Di Magno EP, Malagelada JR: Duodenogastric reflux in humans: Its relationship to fasting antroduodenal motility and gastric, pancreatic and biliary secretion. Gastroenterology 81:726–731, 1981

    PubMed  Google Scholar 

  25. Rovelstad RA: The incompetent pyloric sphincter: Bile and mucosal ulceration. Am J Dig Dis 21:165–173, 1976

    PubMed  Google Scholar 

  26. Costa RB, Alcântara FG: Duodenopatia chagásica. Rev Bras Med 23:158–160, 1966

    PubMed  Google Scholar 

  27. Alcântara FG, Costa RB: Jejunopatia chagásica. Rev Bras Med 23:316–317, 1966

    PubMed  Google Scholar 

  28. Conte VP, Aspectos anátomo-funcionais da vesícula biliar em pacientes com megaesÔfago chagásico. Rev Hosp Clin Fac Med Univ S Paulo 36:60–77, 1981

    Google Scholar 

  29. Villanova MG, Meneghelli UG, Dantas RO: Gallbladder motor function in chagasic patients with megacolon and/or megaesophagus. Digestion 36:189–194, 1987

    PubMed  Google Scholar 

  30. Guelrud M, Bettarello A, Ceconello I, Pinotti HW, Mantelbacher H and Velasquez H: Sphincter of Oddi pressure in chagasic patients with megaesophagus. Gastroenterology 85:584–588, 1983

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Departamento de Clínica Médica, Faculdade de Medicina de RibeirÃo Preto, USP, 14048, RibeirÃo Preto, SP, Brazil

    Luiz Ernesto De Almeida Troncon MD, Joffre Rezende Filho MD & Nassim Iazigi MD

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  1. Luiz Ernesto De Almeida Troncon MD
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  2. Joffre Rezende Filho MD
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  3. Nassim Iazigi MD
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De Almeida Troncon, L.E., Filho, J.R. & Iazigi, N. Duodenogastric reflux in chagas' disease. Digest Dis Sci 33, 1260–1264 (1988). https://doi.org/10.1007/BF01536676

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  • DOI: https://doi.org/10.1007/BF01536676

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