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Roberto Oliveira Dantas - One of the best experts on this subject based on the ideXlab platform.

  • Management of Esophageal Dysphagia in Chagas Disease
    Dysphagia, 2021
    Co-Authors: Roberto Oliveira Dantas
    Abstract:

    Chagas Disease, caused by the infection of the protozoan parasite Trypanosoma cruzi , has clinical consequences in the heart and digestive tract. The most important changes in the digestive tract occur in the esophagus (megaesophagus) and colon (megacolon). Esophageal dysfunction in Chagas Disease results from damage of the esophageal myenteric plexus, with loss of esophageal peristalsis, partial or absent lower esophageal sphincter relaxation, and megaesophagus, which characterizes secondary esophageal achalasia. The treatment options for the Disease are similar to those for idiopathic achalasia, consisting of diet and behavior changes, drugs, botulinum toxin, peroral endoscopic myotomy (POEM), pneumatic dilation of the lower esophageal sphincter, laparoscopic Heller myotomy, and esophagectomy. Chagas Disease causes a life-threatening cardiopathy, and this should be considered when choosing the most appropriate treatment for the Disease. While some options are palliative, for temporary relief of dysphagia (such as drugs, botulinum toxin, and pneumatic dilation), other therapies provide a long-term benefit. In this case, POEM stands out as a modern and successful strategy, with good results in more than 90% of the patients. Esophagectomy is the option in Chagas Disease patients with advanced megaesophagus, despite the increased risk of complications. In these cases, peroral endoscopic myotomy may be an option, which needs further evaluation.

  • Videofluoroscopic Evaluation of Swallowing in Chagas’ Disease
    Dysphagia, 2011
    Co-Authors: Carla Manfredi Santos, Rachel Aguiar Cassiani, Roberto Oliveira Dantas
    Abstract:

    Dysphagia is the most common digestive symptom reported by patients with Chagas’ Disease. The condition results from abnormalities of esophageal motility. Our hypothesis is that there are also alterations of oral and pharyngeal transit during swallowing. We studied by videofluoroscopy the oral and pharyngeal transit during swallowing in 17 patients with dysphagia, a positive serologic test for Chagas’ Disease, and radiologic demonstration of esophageal involvement. The study also included 15 asymptomatic healthy volunteers. Each subject swallowed in duplicate 5 and 10 ml of liquid and paste barium boluses. Chagas’ Disease patients had a longer oropharyngeal transit with the 5-ml liquid bolus ( p  = 0.03), and a longer oral transit ( p  = 0.01) and pharyngeal transit ( p  = 0.04) with the 10-ml liquid bolus than controls. There was no difference between patients and controls with swallows of the 5-ml paste bolus. With swallows of the 10-ml paste bolus, the oropharyngeal transit ( p  = 0.05), pharyngeal transit ( p  = 0.04), pharyngeal clearance ( p  = 0.02), and UES opening ( p  = 0.01) took a longer amount of time in Chagas’ Disease patients than in controls. We conclude that the duration of pharyngeal transit is longer in patients with Chagas’ Disease than in normal subjects, especially with a bolus of pasty consistency and a volume of 10 ml.

  • Esophageal motility of patients with Chagas' Disease and idiopathic achalasia
    Digestive diseases and sciences, 2001
    Co-Authors: Roberto Oliveira Dantas, Neifi Hassan Saloum Deghaide, Eduardo Antônio Donadi
    Abstract:

    Chagas' Disease and idiopathic achalasia have the same neuropathic lesion—the loss of ganglion cells within the esophageal myenteric plexus—with similar clinical, radiologic, and manometric features. However, it is suggested that there are some differences between them. We studied the esophageal motility of 45 patients with Chagas' Disease (seven with esophageal dilation), 27 patients with idiopathic achalasia (13 with esophageal dilation), and 40 asymptomatic volunteers. We used the manometric method with continuous perfusion. 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 alternated with 10 dry swallows. LES pressure was higher in achalasia than in Chagas' 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 patients 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 patients with idiopathic achalasia than in patients with Chagas' Disease and controls (P < 0.05). The results suggest the possibility that the extent of impairment of esophageal innervation differs between Chagas' Disease and idiopathic achalasia.

  • Gastrointestinal manifestations of Chagas’ Disease
    The American journal of gastroenterology, 1998
    Co-Authors: Ricardo Brandt De Oliveira, Luiz Ernesto De Almeida Troncon, Roberto Oliveira Dantas, U G Meneghelli
    Abstract:

    Chagas' Disease is an infectious Disease that affects millions of people in Latin America and is increasingly seen outside endemic areas. A substantial number of patients develop gastrointestinal disorders secondary to lesions of the enteric nervous system. The purpose of this article is to review the current knowledge about gastrointestinal manifestations of Chagas' Disease, including disorders other than the well-known gross dilations of esophagus and colon.

Manoel Otavio Da Costa Rocha - One of the best experts on this subject based on the ideXlab platform.

  • Ventricular arrhythmias in Chagas Disease
    Revista da Sociedade Brasileira de Medicina Tropical, 2015
    Co-Authors: Marco Paulo Tomaz Barbosa, Manoel Otavio Da Costa Rocha, André Assis Lopes Do Carmo, Antonio Luiz Pinho Ribeiro
    Abstract:

    Sudden death is one of the most characteristic phenomena of Chagas Disease, and approximately one-third of infected patients develop life-threatening heart Disease, including malignant ventricular arrhythmias. Fibrotic lesions secondary to chronic cardiomyopathy produce arrhythmogenic substrates that lead to the appearance and maintenance of ventricular arrhythmias. The objective of this study is to discuss the main clinical and epidemiological aspects of ventricular arrhythmias in Chagas Disease, the specific workups and treatments for these abnormalities, and the breakthroughs needed to determine a more effective approach to these arrhythmias. A literature review was performed via a search of the PubMed database from 1965 to May 31, 2014 for studies of patients with Chagas Disease. Clinical management of patients with chronic Chagas Disease begins with proper clinical stratification and the identification of individuals at a higher risk of sudden cardiac death. Once a patient develops malignant ventricular arrhythmia, the therapeutic approach aims to prevent the recurrence of arrhythmias and sudden cardiac death by the use of implantable cardioverter defibrillators, antiarrhythmic drugs, or both. In select cases, invasive ablation of the reentrant circuit causing tachycardia may be useful. Ventricular arrhythmias are important manifestations of Chagas cardiomyopathy. This review highlights the absence of high-quality evidence regarding the treatment of ventricular arrhythmias in Chagas Disease. Recognizing high-risk patients who require specific therapies, especially invasive procedures such as the implantation of cardioverter defibrillators and ablative approaches, is a major challenge in clinical practice.

  • heart rate turbulence in Chagas Disease
    Pacing and Clinical Electrophysiology, 2003
    Co-Authors: Antonio Luiz, Patricia A F Ribeiro, Marcos Roberto De Sousa, Murilo E D Gomes, Amanda Arantes Perez, Fernando Santana Machado, Federico Lombardi, Marcio Vinicius Lins Barros, Georg Schmidt, Manoel Otavio Da Costa Rocha
    Abstract:

    RIBEIRO, A.L.P., et al.: Heart Rate Turbulence in Chagas Disease.Heart rate turbulence (HRT) quantifies the biphasic response of the sinus node to ventricular premature complexes (VPCs) and is a powerful electrocardiogram related risk predictor. VPCs are frequent in Chagas Disease, a potentially lethal illness, and can hamper the analysis by conventional methods of autonomic heart control. The aim of the study was to examine HRT in patients with Chagas Disease. Chagas Disease patients and healthy controls (group0, n = 11) without other Diseases were submitted to a standardized protocol, including electrocardiogram, echocardiography, and 24-hour Holter monitoring. Chagas Disease patients were divided according to their left ventricular systolic function: normal (group1, n = 103) and reduced ejection fraction (group2, n = 23). Two HRT indices, turbulence onset (TO) and turbulence slope (TS), were calculated and compared among groups after adjustment for covariates like the prevalence of VPCs and the mean heart rate. Chagas Disease patients had significantly altered TO (group 1: −0.0186, group 2: −0.0126) and TS (group 1: 10.844, group 2: 7.870) values in comparison with controls (TO − 0.0256, TS 19.829);P < 0.001for both comparisons. In conclusion, HRT data may be useful in the electrocardiographic analysis of autonomic heart control in Chagas Disease. Its prognostic value remains to be determined. (PACE 2003; 26[Pt. II]:406–410)

  • The Valsalva maneuver in Chagas Disease patients without cardiopathy
    International journal of cardiology, 2002
    Co-Authors: Enilce Oliveira, Antonio Luiz Pinho Ribeiro, Fernando Thome De A. Silva, Rosália Moraes Torres, Manoel Otavio Da Costa Rocha
    Abstract:

    Background: The Valsalva maneuver is a simple and reliable test of parasympathetic heart control that can also be used as a trigger of cardiac arrhythmia. Few studies are available about the Valsalva maneuver in Chagas Disease patients without cardiac involvement and their results are contradictory. In a cross-sectional study, we compared Chagas Disease patients without cardiac involvement and normal individuals using the Valsalva maneuver in order to study the vagal cardiac control and the occurrence of cardiac arrhythmia in the early phase of Chagas Disease. Methods: Fifty-nine patients with Chagas Disease without cardiac involvement and 37 controls were submitted to a carefully standardized Valsalva maneuver. Cardiac vagal control was assessed by the Valsalva ratio and the occurrence of cardiac arrhythmia was recorded and coded. Results: The two groups were comparable in terms of left ventricular ejection fraction and left ventricular end-diastolic dimension. When compared to the control group, patients with Chagas Disease had significantly lower Valsalva ratios (1.81±0.41 versus 2.01±0.41, P=0.017) which were not significantly correlated with age, left ventricular function or the presence of radiological esophageal abnormalities. Atrioventricular block (mainly 2nd degree Mobitz type I) occurred exclusively in Chagas Disease patients (15,6%, P=0.021) and may indicate an early involvement of the AV node. Premature ventricular contraction was more frequent in Chagas Disease patients (16.9% versus 8.1%, P=0.217), although the difference was not statistically significant. Conclusion: The Valsalva maneuver is a useful test to detect early vagal dysfunction in Chagas Disease patients without cardiac involvement.

Francois Xavier Lescure - One of the best experts on this subject based on the ideXlab platform.

  • update in treatment of Chagas Disease
    Current Opinion in Infectious Diseases, 2011
    Co-Authors: Guillaume Le Loup, Gilles Pialoux, Francois Xavier Lescure
    Abstract:

    Purpose of reviewThis review discusses the recent data about the pathogenesis of Chagas Disease, tolerance of drugs, and follow-up of patients impacting the treatment of Chagas Disease in immunocompetent and immunocompromised patients.Recent findingsThe role of the parasite to promote direct or indi

Guillaume Le Loup - One of the best experts on this subject based on the ideXlab platform.

  • update in treatment of Chagas Disease
    Current Opinion in Infectious Diseases, 2011
    Co-Authors: Guillaume Le Loup, Gilles Pialoux, Francois Xavier Lescure
    Abstract:

    Purpose of reviewThis review discusses the recent data about the pathogenesis of Chagas Disease, tolerance of drugs, and follow-up of patients impacting the treatment of Chagas Disease in immunocompetent and immunocompromised patients.Recent findingsThe role of the parasite to promote direct or indi

U G Meneghelli - One of the best experts on this subject based on the ideXlab platform.

  • Gastrointestinal manifestations of Chagas’ Disease
    The American journal of gastroenterology, 1998
    Co-Authors: Ricardo Brandt De Oliveira, Luiz Ernesto De Almeida Troncon, Roberto Oliveira Dantas, U G Meneghelli
    Abstract:

    Chagas' Disease is an infectious Disease that affects millions of people in Latin America and is increasingly seen outside endemic areas. A substantial number of patients develop gastrointestinal disorders secondary to lesions of the enteric nervous system. The purpose of this article is to review the current knowledge about gastrointestinal manifestations of Chagas' Disease, including disorders other than the well-known gross dilations of esophagus and colon.