THE SPECTRUM OF ESOPHAGEAL MOTOR DISORDERS IN CHAGAS-DISEASE

Objective: To determine the patterns of esophageal motility found in p atients with Chagas' disease, Methods: Clinical, manometric, and scint igraphic data were obtained from 43 subjects with positive serological tests for Chagas' disease and nondilated esophagus and 10 patients wi th Chagasic megaesophagus. Results: Twenty (46.5%) of the seropositive subjects with nondilated esophagus were asymptomatic, and 23 (53.5%) had dysphagia, but only 12 (27.9%) had persistent dysphagia, a feature typical of Chagasic megaesophagus; only two (4.6%) had chest pain. Ma nometric findings within the seropositive group were: normal motility in 16 subjects, peristaltic multipeaked contractions in three, aperist alsis of the esophagus with relaxing lower esophageal sphincter in nin e, and aperistalsis with nonrelaxing lower esophageal sphincter in 15 subjects. All of 10 megaesophagus patients had aperistalsis of the eso phagus plus nonrelaxing lower esophageal sphincter. Scintigraphy was a s sensitive as manometry in detecting esophageal dysmotility, but the erect scintigraphy was abnormal in subjects with complete aperistalsis only, Conclusion: In Chagas' disease, megaesophagus appears to be a d isorder at the most severe end of a spectrum encompassing classical ac halasia and its milder variants. Other esophageal motility disorders a re rare, but normal esophageal function is common.