Differences between idiopathic and chagasic achalasia

Abstract

Idiopathic and Chagas’ disease achalasia are characterized by absent or partial lower esophageal sphincter relaxation, absence of peristaltic esophageal contraction, food retenction in the esophagus and esophageal dilatation. The most frequent symptoms are dysphagia, regurgitation, heartburn, weight loss and non-cardiac chest pain. The diagnosis is made by radiologic examination and esophageal manometry, which is considered the most accurate exam to characterized achalasia. In both diseases there is destruction of the esophageal myenteric plexus. Despite similarities in clinical and manometric presentation there is evidence of greater loss of inhibitory neurons of the myenteric plexus in idiopathic achalasia, whereas in Chagas’ disease there is a loss of both excitatory and inhibitory neurons. Such differences, though do not affect patients’ clinical presentation, and hence treatment options should be the same for both diseases.

Keywords

Achalasia / Chagas’ disease / megaesophagus / dysphagia / esophageal denervation

References

[1] Jeon HH,Youn YH,Conklin JL.Clinical characteristics of patients with untreat achalasia..J Neurogastroenterol Motil2017;23:370-7 PMCID:PMC5503287

[2] Pressman A.Etiology and pathogenesis of idiopathic achalasia..J Clin Gastroenterol2017;51:1195-201

[3] Crespin OM,Xiao K,Khandelwal S,Oelschlager BK.The relationship between manometric subtype and outcomes of surgical treatments for patients with achalasia..Surg Endosc2017;

[4] Pandolfino JE.Presentation, diagnosis, and management of achalasia..Clin Gastroenterol Hepatol2013;11:887-97

[5] Oliveira RB,Dantas RO.Gastrointestinal manifestations of Chagas' disease..Am J Gastroenterol1998;93:884-9

[6] Matsuda NM,évora PRB.The chronic gastrointestinal manifestations of Chagas' disease..Clinics2009;64:1219-24 PMCID:PMC2797592

[7] Bern C,Herwaldt BL,Marin-Neto JA,Magure JH,Morillo C,Gilman RH,Salvatella R.Evaluation of treatment of Chagas' disease in the United States. A systematic review..JAMA2007;298:2171-81

[8] Sánches-Montalvá A,Mego M,Accarino A,Azpiroz F,Molina I.High resolution esophageal manometry in patients with Chagas' disease: a cross-sectional evaluation..PLoS Negl Trop Dis2016;10:e0004416 PMCID:PMC4744054

[9] Bern C.Chagas' disease..N Engl J Med2015;373:456-66

[10] Köberle F.Chagas' disease and Chagas' syndromes: the pathology of American trypanosomiais..Adv Parasitol1968;6:63-116

[11] Dantas RO.Idiopathic achalasia and chagasic megaesophagus..J Clin Gastroenterol1988;10:13-5

[12] Dantas RO.Comparison between idiopathic achalasia and achalasia caused by Chagas' disease: a review about the pathophysiology of the diseases..Arq Gastroenterol2003;40:126-30

[13] Herbella FAM,Del Grande JC.Are idiopathic and chagasic achalasia two different diseases?.Dig Dis Sci2004;49:353-60

[14] Cohen S,Hughes W.Role of gastrin supersensitivity in the pathogenesis of the lower esophageal sphincter hypertension in achalasia..J Clin Invest1971;50:1241-7 PMCID:PMC292053

[15] Holloway RH,Helm JF,Dent J.Integrity of cholinergic innervations to the lower esophageal sphincter in achalasia..Gastroenterology1986;90:924-9

[16] Dantas RO,Oliveira RB,Troncon LEA.Lower esophageal sphincter pressure in Chagas' disease..Dig Dis Sci1990;35:508-12

[17] Lemme EMO,Pereira VLC,Pantoja J.Lower esophageal sphincter pressure in idiopathic achalasia and Chagas' disease-related achalasia..Dis Esophagus2001;14:232-4

[18] Padovan W,Dantas RO,Oliveira RB.Lower oesophageal sphincter response to pentagastrin in chagasic patients with megaesophagus and megacolon..Gut1980;21:85-90 PMCID:PMC1419352

[19] Dantas RO,Donadi EA.Esophageal motility of patients with Chagas' disease and idiopathic achalasia..Dig Dis Sci2001;46:1200-6

[20] Hirano I.Pathophysiology of achalasia..Curr Gastroenterol Rep1999;1:198-202

[21] Hirano I,Shi G,Joehl RJ.Manometric heterogeneity in patients with idiopathic achalasia..Gastroenterology2001;120:789-98

[22] Dantas RO,Oliveira RB,Troncon LEA.Effect of isosorbide dinitrate and atropine on the lower esophageal sphincter pressure in chagasic patients..Acta Physiol Pharmacol Latinoam1988;38:151-8

[23] Dudnick RS,Castell DO.Abnormal upper esophageal sphincter function in achalasia..Am J Gastroenterol1992;87:1712-5

[24] Ramos RI,Dantas RO.Differences in response of the proximal esophagus to wet swallows in patients of Chagas' disease and idiopathic achalasia..Dis Esophagus2006;19:401-5

[25] Dantas RO.Esophageal contractions in Chagas' disease and in idiopathic achalasia..Dig Dis Sci2005;39:863-8

[26] Goin JC,Bilder CR,Iantorno G,Borda E.Functional implications of circulating muscarinic cholinergic receptor autoantibodies in chagasic patients with achalasia..Gastroenterology1999;117:798-805

[27] Dantas RO,Cassiani LMT.Postfundoplication dysphagia causes similar water ingestion dynamics as achalasia..Arq Gastroenterol2016;53:98-102

[28] Awaiz A,Khan S,Memon MA.Systematic review and meta-analysis of perioperative outcomes of peroral endoscopic myotomy (POEM) and laparoscoic Heller myotomy (LHM) for achalasia..Surg Laparosc Endosc Percutan Tech2017;27:123-31

[29] Kahrilas PJ.Treatments for ahcalasia in 2017: how to choose among them..Curr Opin Gastroenterol2017;33:270-6

[30] Stavros NS,Modayil R.Diagnosis and management of esophageal achalasia..BMJ2016;353:i2785

[31] Patel DA,Vaezi MF.An overwiew of achalasia and its subtypes..Gastroenterol Hepatol2017;13:411-21