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Achalasia: Chagas' Disease

Reference work entry

Pearls and Pitfalls

  • Chagas' disease is related etiologically to the protozoan hemoflagellate, Trypanossoma cruzi with destruction of Meissner’s and Auerbach’s plexuses of the esophagus.

  • Esophagogram and manometry of the esophagus are fundamental for the diagnosis and allow classification into three stages: incipient, non-advanced, and advanced (end stage).

  • Non-operative treatment provides only temporary relief of dysphagia.

  • Cardiomyotomy with partial fundoplication is indicated in the non-advanced variant of achalasia and provides relief of dysphagia.

  • Motility studies confirm a significant decrease of LES pressure after both types of operation, open or laparoscopic.

  • The benefits of minimally invasive surgery include reduction of pain, short hospital stay, and more rapid return to normal activities.

  • Advanced achalasia is treated by transhiatal esophagectomy without thoracotomy and cervical gastroplasty.

  • The occurrence of Barrett's epithelium in the esophageal stump will prompt annual...

Keywords

Lower Esophageal Sphincter Lower Esophageal Sphincter Pressure Partial Fundoplication Sigmoid Volvulus Mucosal Perforation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Selected Readings

  1. Bettarello A, Pinotti HW (1976) Oesophageal involvement in Chagas' disease. Clin Gastroentrol 5:103–117Google Scholar
  2. Cecconello I (1998) Long-term evaluation of gastroplasty in achalasia. In: Siewert R, Holsher AH (eds) Diseases of the esophagus. Springer-Verlag, Berlin, pp. 975–978Google Scholar
  3. Cecconello I, Mariano da Rocha J, Zilberstein B, et al. (1993) Reflux esophagitis and development of ectopic columnar epithelium in the esophageal stump after gastric transposition. In: Nabeia K, Hanaoka T, Nogami T (eds) Recent advances in diseases of the esophagus. Springer-Verlag, BerlinGoogle Scholar
  4. Cunha-Neto E (2001) Understanding the immunopathogenesis of Chagas disease: perspectives for the new millennium. In: Pinotti HW, Cecconello I, Felix VN, Oliveira MA (eds) Recent advances in disease of the esophagus. Manduzzi Editore, Bologna, pp. 197–204Google Scholar
  5. da Silveira AB, Arantes RM, Vago AR, et al. (2005) Comparative study of the presence of Trypanosoma cruzi kDNA, inflammation and denervation in chagasic patients with and without megaesophagus. Parasitology 131:627–634PubMedCrossRefGoogle Scholar
  6. Felix VN (1998) Achalasia: a prospective results of dilatation and myotomy. Hepatogastroenterol 45:97–108Google Scholar
  7. Meneguelli UF (2001) Chagasic megaesophagus – historical aspects and present situation in South America. In: Pinotti HW, Cecconello I, Felix VN, Oliveira MA (eds) Recent advances in disease of the esophagus. Manduzzi Editore, Bologna, pp. 197–204Google Scholar
  8. Moraes-Filho JP, Bettarello A (1989) Response of the lower esophageal sphincter to pentagastrin on patients with megaesophagus secondary to Chagas' disease. Rev Hosp Clin Fac Med Sao Paulo 44:178–180PubMedGoogle Scholar
  9. Pinotti HW (1964) Contribuição para o estudo de fisiopatologia do megaesôfago. Thesis, Faculdade de Medicina da Universidade de São PauloGoogle Scholar
  10. Pinotti HW. (1988) The basis of its treatment. In: Siewert JR, Holscher AH (eds) Diseases of esophagus. Springer-Verlag, Berlin, pp. 17–19Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Digestive Surgery DepartmentSão Paulo University School of MedicineSão PauloBrazil
  2. 2.Digestive Surgery DepartmentSão Paulo University School of MedicineSão PauloBrazil
  3. 3.São Paulo University School of MedicineSão PauloBrazil

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