Chagasic Esophagopathy With Achalasia and Megaesophagus: A Case Report

Chagasic esophagopathy, resulting from Trypanosoma cruzi-induced myenteric plexus denervation, leads to lower esophageal sphincter hypertonia, esophageal body hypertrophy, and dilation (megaesophagus), manifesting as progressive dysphagia and regurgitation that impair nutritional status and quality of life. This case report aims to describe chronic esophageal dysphagia in a patient from an endemic area in northeastern Brazil, highlighting diagnostic and therapeutic challenges within the public health system, including delays due to COVID-19 restrictions and resource limitations. A 67-year-old female from Rio Grande do Norte, with prior Chagas disease diagnosis (2004, etiologically treated), hypertension, and dyslipidemia, presented in 2019 with solid-food dysphagia and nocturnal regurgitation. Initial tests (chest X-ray, ECG, and echocardiography) were normal, but contrast studies (barium esophagogram, and colon) were delayed until 2022, revealing 7 cm esophageal dilation (Rezende Group III), cardia narrowing, and retained contrast/food residues. Symptoms worsened, with a 5 kg weight loss and liquid-only diet. Videolaparoscopic Heller-Pinotti cardiomyotomy was performed in September 2023 after clinical optimization (isosorbide dinitrate and domperidone). The 2 h procedure was uneventful; discharge occurred within 24 h on zero diet, progressing to normal intake by 5 weeks. By February 2024, she was asymptomatic, with a 2 kg weight gain (from 66 kg). This case confirms laparoscopic cardiomyotomy's efficacy (90% success in Rezende I-III) for symptom resolution in nonadvanced chagasic megaesophagus. Public health insights underscore Chagas underreporting, late diagnosis, and public health system barriers in vulnerable populations, advocating early serological screening and etiological treatment in acute phases to prevent chronic digestive forms in endemic regions.