Abnormal progression of a liquid meal through the stomach and small intestine in patients with Chagas' disease

Abstract

This study describes the abnormal pattern of gastrointestinal progression of a liquid meal in patients with the digestive form of chronic Chagas' disease. This condition is known as a natural model of intramural denervation of the gut. Sixteen patients with clinical and radiographic evidence of esophageal and/or colonic involvement and 18 healthy volunteers were studied. Orocecal transit time after the ingestion of a 10% lactulose solution (180 ml) tagged with 99mtechnetium was measured by a conventional H2 breath technique. Gastric emptying and the arrival of the front of the meal to regions of interest corresponding to proximal and distal areas of the small intestine were assessed by abdominal scintigraphy. Orocecal transit time was significantly greater (P < 0.05) in Chagas' disease patients (N = 13) than in control subjects (N = 18) (mean +/- SD: 100.7 +/- 48.7 min vs 62.9 +/- 18.2 min). Half-time for gastric emptying of liquids in chagasic patients (N = 9) was significantly lower (P < 0.01) than in controls (N = 7) (9.7 +/- 2.7 min vs 26.4 +/- 3.4 min). The time of arrival of the liquid meal to the proximal small intestine was also significantly shorter (P < 0.02) in patients than in controls (5.6 +/- 3.7 vs 11.4 +/- 5.5 min), but there was no difference between the two groups concerning the time the meal first arrived to the distal small intestine (15.0 +/- 11.0 min vs 23.5 +/- 11.4 min, P > 0.05). These results indicate that patients with Chagas' disease have a combination of exceedingly rapid gastric emptying and abnormally delayed transit of liquids through the more distal segments of the small bowel.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis, management and treatment of chronic Chagas’ gastrointestinal disease in areas where Trypanosoma cruzi infection is not endemic

“…Such hypertrophy becomes less apparent in very advanced forms of the disease. 35 The ultimate outcome of the motor disorders, with sphincter discoordination and increased intraluminal pressure, is progressive dilatation and a reduction of organ contractile capacity. In addition, the muscularis mucosa can become hypertrophic, and there have been reports of hyperplastic and dysplastic alterations of the oesophageal epithelium favouring an increase in the number of cases of carcinoma.…”

Dysphagia in Patients with Chagas' Disease

“…Other organs of the digestive tract are also impaired, although with fewer clinical implications [3][4][5][6][7]. In the acute phase of the disease the esophageal myenteric plexus is destroyed to a different extent in each subject.…”

Chagasic enteropathy

“…These studies showed a delayed arrival of the test meal to the cecum associated with slow transit in the distal small bowel 69 .…”