Sánchez-Montalvá Adrián, Moris María, Mego Marianela, Salvador Fernando, Accarino Anna, Ramírez Kathleen, Azpiroz Fernando, Ruiz-de-Leon Antonio, Molina Israel
Infectious Diseases Department, Tropical Medicine Unit, PROSICS (International Health Program of the Catalan Health Institute), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
Digestive System Research Unit, Vall d'Hebron University Hospital, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
PLoS Negl Trop Dis. 2016 Feb 5;10(2):e0004416. doi: 10.1371/journal.pntd.0004416. eCollection 2016 Feb.
Gastrointestinal involvement affects 30-40% of the patients with chronic Chagas disease. Esophageal symptoms appear once the structural damage is established. Little is known about the usefulness of high resolution manometry to early identification of esophageal involvement.
We performed a cross-sectional study at the Vall d'Hebron University Hospital (Barcelona, Spain) between May 2011 and April 2012. Consecutive patients diagnosed with Chagas disease in the chronic phase were offered to participate. All patients underwent a structured questionnaire about digestive symptoms, a barium esophagogram (Rezende classification) and an esophageal high resolution manometry (HRM). A control group of patients with heartburn who underwent an esophageal HRM in our hospital was selected.
62 out of 73 patients that were included in the study fulfilled the study protocol. The median age of the Chagas disease group (CG) was 37 (IQR 32-45) years, and 42 (67.7%) patients were female. Twenty-seven (43.5%) patients had esophageal symptoms, heartburn being the most frequent. Esophagogram was abnormal in 5 (8.77%). The esophageal HRM in the CG showed a pathological motility pattern in 14 patients (22.6%). All of them had minor disorders of the peristalsis (13 with ineffective esophageal motility and 1 with fragmented peristalsis). Hypotonic lower esophageal sphincter was found more frequently in the CG than in the control group (21% vs 3.3%; p<0.01). Upper esophageal sphincter was hypertonic in 22 (35.5%) and hypotonic in 1 patient. When comparing specific manometric parameters or patterns in the CG according to the presence of symptoms or esophagogram no statistically significant association were seen, except for distal latency.
The esophageal involvement measured by HRM in patients with chronic Chagas disease in our cohort is 22.6%. All the patients with esophageal alterations had minor disorders of the peristalsis. Symptoms and esophagogram results did not correlate with the HRM results.
胃肠道受累影响30%-40%的慢性恰加斯病患者。一旦出现结构损伤，食管症状就会出现。关于高分辨率测压法在早期识别食管受累方面的效用，人们了解甚少。
2011年5月至2012年4月期间，我们在西班牙巴塞罗那的瓦尔德希伯伦大学医院进行了一项横断面研究。邀请连续诊断为慢性期恰加斯病的患者参与。所有患者均接受了关于消化症状的结构化问卷调查、钡餐食管造影（雷森德分类法）和食管高分辨率测压（HRM）。选取了在我院接受食管HRM检查的烧心患者作为对照组。
纳入研究的73例患者中有62例符合研究方案。恰加斯病组（CG）的中位年龄为37岁（四分位间距32-45岁），42例（67.7%）患者为女性。27例（43.5%）患者有食管症状，烧心最为常见。食管造影异常的有5例（8.77%）。CG组的食管HRM显示14例患者（22.6%）存在病理性运动模式。他们均有轻微的蠕动障碍（13例为无效食管动力，1例为蠕动破碎）。CG组中发现食管下括约肌张力低下的情况比对照组更频繁（21%对3.3%；p<0.01）。22例（35.5%）患者的食管上括约肌张力亢进，1例患者张力低下。根据症状或食管造影的存在情况比较CG组的特定测压参数或模式时，除了远端潜伏期外，未发现有统计学意义的关联。
在我们的队列中，慢性恰加斯病患者通过HRM测量的食管受累率为22.6%。所有有食管改变的患者均有轻微的蠕动障碍。症状和食管造影结果与HRM结果不相关。
