Esophageal motility of patients with Chagas' disease and idiopathic achalasia

Chagas' disease and idiopathic achalasia have the same neuropathic lesion-t he loss of ganglion cells within the esophageal myenteric plexus-with simil ar clinical, radiologic, and manometric features. However, it is suggested that there are some differences between them. We studied the esophageal mot ility of 45 patients with Chagas' disease (seven with esophageal dilation), 27 patients with idiopathic achalasia (13 with esophageal dilation), and 4 0 asymptomatic volunteers. We used the manometric method with continuous pe rfusion. The lower esophageal sphincter (LES) pressure was measured by the rapid pull-through method. Esophageal contractions was evaluated at 5, 10, and 15 cm above the LES, after 10 swallows of a 5-ml bolus of water alterna ted with 10 dry swallows. LES pressure was higher in achalasia than in Chag as' disease patients and controls (P < 0.05). Amplitude of contraction was lower in all patient groups compared with controls (P < 0.01) and lower in patients with dilation compared with patients without dilation (P < 0.05). The contraction duration was longer in patients with achalasia than in pati ents with Chagas' disease and controls (P < 0.05). The percentage of failed contractions was higher in Chagas' disease than in achalasia and controls (P < 0.05), and the percentage of simultaneous contractions was higher in p atients with idiopathic achalasia than in patients with Chagas' disease and controls (P < 0.05). The results suggest the possibility that the extent o f impairment of esophageal innervation differs between Chagas' disease and idiopathic achalasia.