Aprile L R, Troncon L E, Meneghelli U G, de Oliveira R B
Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Hospital das Clínicas, Campus da USP, SP, Brasil.
Arq Gastroenterol. 1995 Apr-Jun;32(2):71-8.
We report two cases of Chagas' disease with megacolon who presented with chronic diarrhea. One of the patients also had evidence of malabsorption, such as steatorrhea and hypocalcemia. Barium meal follow-through showed remarkable dilation of the jejunum in both cases and, in one of them, an associated megaduodenum. Manometric studies of gastrointestinal motility showed abnormally slow propagation of the interdigestive migrating motor complex, which was also excessively prolonged. Cultivation of jejunal aspirates revealed strict anaerobic bacterial growth in both cases. Oral antibiotic therapy led to substantial improvement in symptoms. The two cases herein reported indicate that clinical manifestations of small bowel bacterial overgrowth, possibly caused by motor disturbances associated with megajejunum, may occasionally include the clinical picture of gastrointestinal involvement in Chagas' disease.
我们报告了两例患有巨结肠的恰加斯病患者,他们均表现为慢性腹泻。其中一名患者还存在吸收不良的证据,如脂肪泻和低钙血症。钡餐造影显示,两例患者的空肠均显著扩张,其中一例还伴有巨十二指肠。胃肠动力测压研究表明,消化间期移行性运动复合波的传播异常缓慢,且持续时间过长。对空肠吸出物进行培养发现,两例患者均有严格厌氧菌生长。口服抗生素治疗使症状得到显著改善。本文报告的这两例病例表明,小肠细菌过度生长的临床表现,可能由与巨空肠相关的运动障碍引起,偶尔可能包括恰加斯病累及胃肠道的临床表现。