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The Spectrum of Esophageal Dismotility in Chagas Disease on High-Resolution Esophageal Manometry As Defined By
Felipe N Mendonça1, Gardênia C do Carmo, Gustavo de Assis Mota
1Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
Insights
Chagas disease (CD) can cause various esophageal motility disorders, with achalasia being the most common. Applying the Chicago Classification v4.0 (CCv4.0) helps standardize diagnosis in high-resolution esophageal manometry (HREM) studies.
Area of Science:
- Gastroenterology
- Clinical Medicine
- Esophageal Motility Disorders
Background:
- Esophageal motor patterns in Chagas disease (CD) have been studied using high-resolution esophageal manometry (HREM).
- Previous HREM studies in CD lacked standardization due to the absence of the Chicago Classification v4.0 (CCv4.0) criteria.
- This gap highlights the need for a standardized approach to classify esophageal dysfunction in CD.
Purpose of the Study:
- To identify and characterize the spectrum of esophageal motor disorders in Chagas disease (CD).
- To apply the standardized criteria of the Chicago Classification v4.0 (CCv4.0) for diagnosis.
- To analyze manometric patterns based on referral source and clinical presentation.
Main Methods:
- Retrospective analysis of high-resolution esophageal manometry (HREM) data from 129 patients with positive Chagas disease serology.
- Re-evaluation of HREM plots using the Chicago Classification v4.0 (CCv4.0) criteria.
- Inclusion of motor responses to multiple rapid swallows (MRS) and review of electronic medical records for clinical data.
Main Results:
- Achalasia was the most prevalent esophageal motor disorder (32.6%), followed by normal motility (23.2%), absent contractility (16.3%), and ineffective esophageal motility (12.4%).
- Esophagogastric junction outflow obstruction (EGJOO) was observed in 14.7% of patients (12.4% inconclusive, 2.3% conclusive).
- Manometric patterns varied by referral source, and MRS parameters, including integrated relaxation pressure (IRP), showed abnormalities in a subset of patients.
Conclusions:
- The Chicago Classification v4.0 (CCv4.0) identifies achalasia in nearly half of Chagas disease (CD) patients, with significant proportions showing normal or hypocontractile patterns.
- Standardized classification using CCv4.0 clarifies previous discrepancies in manometric findings across different studies.
- Understanding these patterns is crucial for accurate diagnosis and management of esophageal dysfunction in CD.
Background:
Esophageal motor patterns associated with Chagas disease (CD) have been examined in several high-resolution esophageal manometry (HREM) studies involving cohorts with varying characteristics and outcomes. None of these studies applied the Chicago Classification v4.0 (CCv4.0).
Goals:
This study aimed to identify the spectrum of esophageal motor disorders related to CD based on the criteria outlined in CCv4.0.
Study:
The study included 129 patients with positive serologic tests for CD and no anatomic obstructive lesions, referred to HREM from identified sources. The HREM plots were retrieved and reanalyzed according to CCv4.0. Motor responses to multiple rapid swallows (MRS) were included in the analysis. The electronic medical records were scrutinized for demographic, medical, and radiographic data.
Results:
Achalasia was the most frequent pattern (32.6%), followed by normal (23.2%), absent contractility (AC) (16.3%), inconclusive esophagogastric junction outflow obstruction (EGJOO) (12.4%), ineffective esophageal motility (IEM) (12.4%) and conclusive EGJOO (2.3%). Diagnostic profiles varied by referral source. Among patients with obstructive symptoms, 44% had achalasia, 17% AC, 13% normal, 12% IEM, 10% inconclusive EGJOO, and 3% conclusive EGJOO. MRS motor responses in CD varied among different esophageal motor patterns. Sitting MRS-IRP was abnormal in 35% of patients with AC.
Conclusions:
On the basis of CCv4.0 criteria, achalasia is identified in nearly half of individuals with CD, whereas normal and hypocontractile motility patterns are present in a substantial proportion of cases. Differences in manometric patterns according to the source of referral clarify discrepancies found in earlier studies.
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