Management of Chronic Digestive Involvement in Patients with Chagas Disease in Endemic and Non-endemic Countries: Challenges and Limitations

Abstract

Patients with Chagas disease (CD) with digestive involvement commonly present with dysphagia or constipation or otherwise do not have any digestive symptoms but have a positive serology for CD and are referred for further evaluation. Radiological examination is the first test to be done in order to make the diagnosis. The barium oesophagogram with fluoroscopy shows not only the degree of oesophageal dilation but also functional alterations such as abnormal or absence of peristaltic contractions and the rate of oesophageal emptying. In advanced megaoesophagus in which great oesophageal dilation is found, no further tests need to be performed to diagnose the oesophageal involvement in CD. In those cases, in which there is mild or no oesophageal dilation, performing oesophageal manometry could confirm the diagnosis. In order to demonstrate colon dilation, barium enema can be performed using a simplified method without previous preparation in which rectal and sigmoid enlargement can be easily demonstrated. The treatment of chagasic megaoesophagus can be done by means of dietary measures, clinical treatment, endoscopic balloon dilation, surgery, and per oral endoscopic myotomy. The treatment will depend upon the stage of the disease, the patient profile and the availability of the method. The treatment of the constipation associated with Chagas colopathy can be done with dietary and habits modifications, use of laxatives and surgical treatment. The surgical treatment of chagasic megacolon is indicated for those cases that present with great sigmoid dilation, prolonged faeces retention, recurrence of fecalomas, and repeated sigmoid volvulus.