Prevalence of rectoanal inhibitory reflex in chagasic megacolon

Cavenaghi, Simone; Felicio, Otaviano Cardoso da Silva; Ronchi, Luiz Sérgio; Cunrath, Geni Satomi; Melo, Marcelo Maia Caixeta de; Netinho, João Gomes

doi:10.1590/s0004-28032008000200007

Cited by 13 publications

(11 citation statements)

References 14 publications

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“…Others have demonstrated an absence of the rectoanal inhibitory reflex in the chagasic megacolon, similar to that in Hirschsprung’s disease 68,69. Alteration of the rectoanal inhibitory reflex in most of the chagasic patients with megacolon was demonstrated by several researchers and can be justified by the destruction of enteric motor innervations 6,11,19,20,22,24,25,68,70. The choice of surgical treatment appears to have the same indication as a solution for constipation in both chagasic and idiopathic megacolon 71,72…”

Section: Discussionmentioning

confidence: 68%

“…In addition, the studies show a lack of relaxation of the internal sphincter of the anus in the chagasic patients 6,11. Others have demonstrated an absence of the rectoanal inhibitory reflex in the chagasic megacolon, similar to that in Hirschsprung’s disease 68,69. Alteration of the rectoanal inhibitory reflex in most of the chagasic patients with megacolon was demonstrated by several researchers and can be justified by the destruction of enteric motor innervations 6,11,19,20,22,24,25,68,70.…”

Section: Discussionmentioning

confidence: 94%

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The Chronic Gastrointestinal Manifestations of Chagas Disease

Matsuda

Miller

Evora

2009

Clinics

147

119

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Chagas disease is an infectious disease caused by the protozoan Trypanosoma cruzi. The disease mainly affects the nervous system, digestive system and heart. The objective of this review is to revise the literature and summarize the main chronic gastrointestinal manifestations of Chagas disease. The chronic gastrointestinal manifestations of Chagas disease are mainly a result of enteric nervous system impairment caused by T. cruzi infection. The anatomical locations most commonly described to be affected by Chagas disease are salivary glands, esophagus, lower esophageal sphincter, stomach, small intestine, colon, gallbladder and biliary tree. Chagas disease has also been studied in association with Helicobacter pylori infection, interstitial cells of Cajal and the incidence of gastrointestinal cancer.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 94%

The Chronic Gastrointestinal Manifestations of Chagas Disease

Matsuda

Miller

Evora

2009

Clinics

147

119

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“…18 However, even excluding patients with megarectum (in whom the standard distending balloon may have failed to stimulate sufficiently the rectal pouch), we were unable to find impaired anorectal inhibitory reflex. Others have postulated that an impaired anorectal inhibitory reflex is a pathogenetic factor in chagasic megacolon; but it has been also observed that not all patients with megarectum present an impaired anorectal inhibitory reflex, which suggests that other abnormalities may also play a role in the development of megarectum and megacolon.…”

Section: Discussionmentioning

confidence: 57%

Assessment of Rectocolonic Morphology and Function in Patients with Chagas Disease in Barcelona (Spain)

Salvador¹,

Mego²,

Sánchez-Montalvà³

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract. The aim of this study was to determine the relationship between colonic symptoms, radiological abnormalities, and anorectal dysfunction in patients with Chagas disease. We performed a cross-sectional study of untreated patients diagnosed with Chagas disease. All patients were evaluated clinically (by a questionnaire for colonic symptoms based on Rome III criteria) and underwent a barium enema and anorectal manometry. A control group of patients with functional constipation and without Chagas disease was included in the study. Overall, 69 patients were included in the study: 42 patients were asymptomatic and 27 patients had abdominal symptoms according to Rome III criteria. Anorectal manometry showed a higher proportion of abnormalities in symptomatic patients than in asymptomatic ones (73% versus 21%, respectively; P 0.0001).

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“…A lack of relaxation of the internal anal sphincter and an absence of the rectoanal inhibitory reflex (RAIR) were demonstrated in chronic chagasic patients with megacolon 17 ; this finding could be explained by the presence of aganglionosis. However, in some patients, the absence of the RAIR could be the result of megarectum rather than the expression of a true aganglionosis 18 .…”

Section: From Classical and Recent Morphologic Studies To Manometric mentioning

confidence: 99%

Gastrointestinal involvement in Chagas disease

Bilder¹,

Goin²

2018

NGL

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Achalasia and megacolon are the second most common manifestations of chronic Chagas disease (ChD) in endemic areas of Central and South America. Twenty or even more years after the initial infection, approximately one-third of infected people develop cardiac and/ or gastrointestinal abnormalities as typical chronic damages of ChD. The chronic phase of ChD is characterized by the damage of myenteric (intrinsic) and autonomic (extrinsic) neurons. A decreased density of enteric glial cells can be detected in patients with megaesophagus and megacolon and a loss of interstitial cells of Cajal. These lesions affect the complex mechanisms of neural, molecular, and cellular interactions that modulate the motor activity and other specific functions of the alimentary tract. Evidence for serum antibodies with the ability to recognize similar epitopes in both Trypanosoma cruzi and host antigens suggested that molecular mimicry could play a substantial role in the pathophysiology of chronic ChD. In fact, a high prevalence of circulating antibodies against M2 acetylcholine muscarinic receptor (M2R) in ChD patients with achalasia and megacolon has been found. These antibodies bind to and activate M2R, exhibiting agonist-like activity. Anti-M2R antibodies can both enhance tonic contraction in lower esophagus and distal colon by direct stimulation and also by counteracting the relaxant effect of drugs that increase cAMP accumulation (i.e. beta-adrenergic agonists). The biochemical and functional effects of these antibodies on esophageal and colon smooth muscle could play an important role in the pathophysiology of achalasia and megacolon secondary to ChD.

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Prevalence of rectoanal inhibitory reflex in chagasic megacolon

Cited by 13 publications

References 14 publications

The Chronic Gastrointestinal Manifestations of Chagas Disease

The Chronic Gastrointestinal Manifestations of Chagas Disease

Assessment of Rectocolonic Morphology and Function in Patients with Chagas Disease in Barcelona (Spain)

Gastrointestinal involvement in Chagas disease

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