AMERICAN TRYPANOSOMIASIS (CHAGAS-DISEASE)

Gastrointestinal dysfunction is a major problem for many patients with chronic Chagas' disease, as are cardiac dysrhythmias and cardiomyopat hy. The underlying anatomic abnormality in these patients is a denerva tion of the gastrointestinal tract. This process of nerve destruction usually develops insidiously over many years, and it is highly variabl e in terms of its extent in individual patients as well as in tile seg ments of the gastrointestinal tract that are most affected. Megaesopha gus is the most common manifestation of gastrointestinal Chagas diseas e, and mechanical dilation of the esophageal sphincter or surgery in a dvanced cases usually give satisfactory relief of symptoms. Megacolon, particularly of the sigmoid segment, is also common in patients with chronic T. cruzi infections, and its presence can be complicated by fe cal impaction or sigmoid volvulus. Patients with advanced megacolon wh o have resections of the sigmoid colon and most of the rectum generall y do well postoperatively.