Relationship of Functional Changes to Structural Changes in Megaesophagus of Chagas’ Disease
The denervation of the intrinsic nerves of the esophagus (1) in Chagas’ disease has been attributed to activated lymphocytes following trypanasoma crusi infection (2). deRezendez and co-workers have classified the severity of the disease radiologically (3) and manometrically (4) into four groups. Complete retention of contrast media, gross dilatation and elongation of the esophageal body with complete loss of motor activity on x-ray was described for group 4, with other groups being intermediate. By manometry increased lower esophageal sphincter pressure and length and 95% loss of sphincter relaxation with swallowing characterized group 3. Increased sensitivity to methacholine (5) also occurs in Chagasics (2). Extremes of temperature induced increased contractile disco-ordination in group 2 (6). Pentagastrin contractions were found to be less in Chagasic patients (7). Since deRezendez (unpublished studies) found the reduction in LES relaxation by glucagon related to the severity of the disease, the reduced pentagastrin response may reflect a loss of cholinergie nerves.
KeywordsGastrointestinal Motility Lower Esophageal Sphincter Pressure Muscle Bundle Nerve Bundle Esophageal Body
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