The Experts below are selected from a list of 285 Experts worldwide ranked by ideXlab platform
Eduardo Crema - One of the best experts on this subject based on the ideXlab platform.
-
HPV detection within a case series of chagasic Megaesophagus associated or not with esophageal squamous cell carcinoma
2020Co-Authors: Fernanda Franco Munari, Eduardo Crema, Laura Sichero, Adriana Cruvinel-carloni, Croider Franco Lacerda, Emily Montosa Nunes, Antônio Talvane Torres De Oliveira, Cristovam Scapulatempo-neto, Sandra Regina Morini Da Silva, Sheila Jorge AdadAbstract:Abstract Background Chagasic Megaesophagus (clinical manifestation of chagasic disease) has been reported as an etiological factor for squamous cell carcinoma of the esophagus, as well as the presence of human papillomavirus (HPV). Objective We accessed the prevalence of HPV DNA in a series of squamous cell carcinomas of the esophagus associated or not with the chagasic Megaesophagus, and within samples of chagasic Megaesophagus without cancer. Data obtained was further correlated to the pathological clinical data of affected individuals. Methods Retrospective study that used a total 92 samples tissue/biopsy specimens of formalin fixed and paraffin embedded tissues were retrospectively collected from the southeast region of Brazil from patients treated in three hospitals: Barretos Cancer Hospital, Barretos, São Paulo; Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais; and São Paulo State University (UNESP), Botucatu, São Paulo. Cases were divided in three groups: i) 24 patients with chagasic Megaesophagus associated with esophageal ESCC (CM/ESCC); ii) 37 patients with esophageal ESCC without chagasic Megaesophagus (ESCC); iii) 31 patients with chagasic Megaesophagus without esophageal ESCC (CM). Results We detected a higher prevalence of high-risk HPVs in patients from both CM (12/31, 38.8%) and CM/ESCC groups (8/24, 33.3%), as compared to individuals of the ESCC group (6/37, 16.3%), although data was not statistically significant. We further observed that HPV-16 was more prevalent in patients of the ESCC (4/9, 44.5%) and CM/ESCC groups (2/8, 25.0%). In addition, some of these samples presented infection by multiple HPV types. High-risk HPVs detected were HPV-31, 45, 51, 53, 56, 66, and 73, of which the majority was identified in patients from the CM group. Furthermore, low-risk HPV-11 and HPV-70 were identified in individuals from both ESCC and CM groups. Conclusion This is the first report regarding the presence of HPV DNA in Megaesophagus associated with esophageal squamous cell carcinoma. In the present study, HPV infection appears to be directly related to the development of esophageal squamous cell carcinoma in patients with chagasic Megaesophagus. Further studies are warrantee to confirm and better understand the role of oncogenic HPV persistent infection in these patients.
-
pik3ca mutations are frequent in esophageal squamous cell carcinoma associated with chagasic Megaesophagus and are associated with a worse patient outcome
Infectious Agents and Cancer, 2018Co-Authors: Fernanda Franco Munari, Eduardo Crema, Sheila Jorge Adad, Croider Franco Lacerda, Adriana Cruvinelcarloni, Antonio Talvane Torres De Oliveira, Cristovam Scapulatemponeto, Sandra Regina Morini Da Silva, Maria Aparecida Marchesan Rodrigues, Maria Aparecida Coelho De Arruda HenryAbstract:Background Chronic diseases such as chagasic Megaesophagus (secondary to Chagas’ disease) have been suggested as etiological factors for esophageal squamous cell carcinoma; however, the molecular mechanisms involved are poorly understood.
-
prevalence of cholelithiasis in patients with chagasic Megaesophagus
Revista Da Sociedade Brasileira De Medicina Tropical, 2011Co-Authors: Eduardo Crema, Ellen Caroline Rosa Resende Silva, Priscila Melo Franciscon, Virmondes Rodrigues, Aiodair Martins, Celso Teles, Alex Augusto SilvaAbstract:INTRODUCTION: The prevalence of cholelithiasis in the general population ranges from 9 to 18%. This prevalence is known to be higher in the presence of parasympathetic nerve damage of the biliary tract either due to surgery (vagotomy) or neuronal destruction (Chagas disease). The objective of this study was to evaluate the association of cholelithiasis and chagasic or idiopathic Megaesophagus. METHODS: The ultrasound scans of 152 patients with Megaesophagus submitted to cardiomyotomy and subtotal esophagectomy surgery were evaluated. The presence of cholelithiasis was compared between chagasic and idiopathic esophagopathy and ultrasound and clinical findings were correlated with age, sex and race. RESULTS: A total of 152 cases of Megaesophagus, including 137 with chagasic Megaesophagus and 15 with idiopathic Megaesophagus, were analyzed. The mean age was 56.7 years (45-67) in the 137 patients with chagasic Megaesophagus and 35.6 years (27-44) in the 15 cases of idiopathic Megaesophagus, with a significant difference between the two groups (p < 0.0001). The group with chagasic Megaesophagus consisted of 59 (43%) women and 78 (56.9%) men, while the group with idiopathic Megaesophagus consisted of 8 (53.3%) women and 7 (46.6%) men, showing no significant difference between the groups. Of the 137 patients with confirmed chagasic Megaesophagus, 39 (28.4%) presented cholelithiasis versus one case (6.6%) in the 15 patients with idiopathic Megaesophagus. CONCLUSIONS: The prevalence of cholelithiasis is high in patients with chagasic Megaesophagus and preoperative ultrasound should be performed routinely in these patients in order to treat both conditions during the same surgical procedure.
-
laparoscopic transhiatal esophagectomy for the treatment of advanced Megaesophagus an analysis of 60 cases
Revista do Colégio Brasileiro de Cirurgiões, 2009Co-Authors: Eduardo Crema, Alex Augusto Silva, Lara Beatriz Prata Ribeiro, Juverson A Terra, Renato Costa Sousa, Bruna Ferrante Silva, Athos Vargas SilvaAbstract:OBJECTIVES: We studied and demonstrated that the technique of subtotal esophagectomy, through laparoscopic and transmediastinal access, in order to prepare the stomach, to dissect the abdominal and thoracic esophagus, and to perform a left cervicotomy for esophageal removal and to proceed with an esophagogastric anastomosis is a good choice and it is a safe method for advanced Megaesophagus treatment. METHODS: Sixty transhiatal esophagectomies by laparoscopy were performed between September 1996 and December 2006, with preservation of the vagus nerve in the last ten cases. The mean age of the patients was 56.4 years-old (18-76) and they were submitted to preoperative blood tests for T. Cruzi, esophagography, high-resolution digestive endoscopy, electromanometry, biliary ultrasound, and 24-hour ph-metry. Also a nutritional evaluation, respiratory physiotherapy and enteral nutritional support, using a nasoenteral tube were done. The indications for this surgery were radiologically and functionally advanced Megaesophagus, recurrence of Megaesophagus after surgery involving the esophageal junction and association of severe dysplasia and/or neoplasia. The follow-up period was from six to 118 months. RESULTS: There was no mortality, the mean surgery time was 160 minutes (110 to 325), and improvement was noted in all evaluated parameters. Twelve of 60 (20%) patients presented with complications; eight cases had hemopneumothorax (13.33%); three cases had gastric stasis (5%); four cases had cervical fistulae (6.67%), and resolution was achieved with non operative treatment; nine cases had dysphonia (15%). CONCLUSION: The results observed in laparoscopic transhiatal esophagectomy were encouraging. They demonstrated that this is a practical and safe technique with excellent postoperative results.
-
laparoscopic transhiatal subtotal esophagectomy for the treatment of advanced Megaesophagus
The Annals of Thoracic Surgery, 2005Co-Authors: Eduardo Crema, Lara Beatriz Prata Ribeiro, Juverson A Terra, Alex Augusto SilvaAbstract:Background Chagas' disease affects about 5 to 8 million individuals in Brazil, with 5% to 8% of them developing Megaesophagus. In view of the transformation of the esophagus into an inert tube unable to propel food to the stomach, and in order to prevent complications, the elected treatment for advanced Megaesophagus is subtotal esophagectomy. We evaluate here the outcome of laparoscopic transhiatal subtotal esophagectomy in the treatment of advanced Megaesophagus. Methods Thirty patients with advanced esophagopathy, 26 with chagasic and 4 with idiopathic Megaesophagus, were submitted to transhiatal subtotal esophagectomy without thoracotomy through laparoscopy and left cervicotomy. Contrast exams of the esophagus, stomach, and duodenum (ESD), upper digestive tract endoscopy (UDE), esophageal electromanometry, and 24-hour pHmetry were performed during the preoperative and postoperative period. With respect to the surgical technique, pyloroplasty was not performed. The cervical esophagus was dissected through a left cervicotomy and the esophagogastric anastomosis was performed between the cervical segment of the esophagus and the posterior wall of the stomach. Results No death or conversion to open surgery occurred in the present series. Complications were observed in 8 patients (26.7%): 6 cases of pneumothorax (20%), 2 of cervical fistulas (6.7%), 7 of transient dysphonia (23.3%), and 1 of anastomotic esophagogastric stenosis (3.3%). One (3.3%) of the patients developed dysphagia for solid food after 36 months despite normal ESD, UDE, electromanometry, and 24-hour pHmetry. Conclusions The present results show that laparoscopic transhiatal subtotal esophagectomy is a feasible and safe procedure with an excellent postoperative outcome.
Sheila Jorge Adad - One of the best experts on this subject based on the ideXlab platform.
-
HPV detection within a case series of chagasic Megaesophagus associated or not with esophageal squamous cell carcinoma
2020Co-Authors: Fernanda Franco Munari, Eduardo Crema, Laura Sichero, Adriana Cruvinel-carloni, Croider Franco Lacerda, Emily Montosa Nunes, Antônio Talvane Torres De Oliveira, Cristovam Scapulatempo-neto, Sandra Regina Morini Da Silva, Sheila Jorge AdadAbstract:Abstract Background Chagasic Megaesophagus (clinical manifestation of chagasic disease) has been reported as an etiological factor for squamous cell carcinoma of the esophagus, as well as the presence of human papillomavirus (HPV). Objective We accessed the prevalence of HPV DNA in a series of squamous cell carcinomas of the esophagus associated or not with the chagasic Megaesophagus, and within samples of chagasic Megaesophagus without cancer. Data obtained was further correlated to the pathological clinical data of affected individuals. Methods Retrospective study that used a total 92 samples tissue/biopsy specimens of formalin fixed and paraffin embedded tissues were retrospectively collected from the southeast region of Brazil from patients treated in three hospitals: Barretos Cancer Hospital, Barretos, São Paulo; Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais; and São Paulo State University (UNESP), Botucatu, São Paulo. Cases were divided in three groups: i) 24 patients with chagasic Megaesophagus associated with esophageal ESCC (CM/ESCC); ii) 37 patients with esophageal ESCC without chagasic Megaesophagus (ESCC); iii) 31 patients with chagasic Megaesophagus without esophageal ESCC (CM). Results We detected a higher prevalence of high-risk HPVs in patients from both CM (12/31, 38.8%) and CM/ESCC groups (8/24, 33.3%), as compared to individuals of the ESCC group (6/37, 16.3%), although data was not statistically significant. We further observed that HPV-16 was more prevalent in patients of the ESCC (4/9, 44.5%) and CM/ESCC groups (2/8, 25.0%). In addition, some of these samples presented infection by multiple HPV types. High-risk HPVs detected were HPV-31, 45, 51, 53, 56, 66, and 73, of which the majority was identified in patients from the CM group. Furthermore, low-risk HPV-11 and HPV-70 were identified in individuals from both ESCC and CM groups. Conclusion This is the first report regarding the presence of HPV DNA in Megaesophagus associated with esophageal squamous cell carcinoma. In the present study, HPV infection appears to be directly related to the development of esophageal squamous cell carcinoma in patients with chagasic Megaesophagus. Further studies are warrantee to confirm and better understand the role of oncogenic HPV persistent infection in these patients.
-
pik3ca mutations are frequent in esophageal squamous cell carcinoma associated with chagasic Megaesophagus and are associated with a worse patient outcome
Infectious Agents and Cancer, 2018Co-Authors: Fernanda Franco Munari, Eduardo Crema, Sheila Jorge Adad, Croider Franco Lacerda, Adriana Cruvinelcarloni, Antonio Talvane Torres De Oliveira, Cristovam Scapulatemponeto, Sandra Regina Morini Da Silva, Maria Aparecida Marchesan Rodrigues, Maria Aparecida Coelho De Arruda HenryAbstract:Background Chronic diseases such as chagasic Megaesophagus (secondary to Chagas’ disease) have been suggested as etiological factors for esophageal squamous cell carcinoma; however, the molecular mechanisms involved are poorly understood.
-
an imbalance between substance p and vasoactive intestinal polypeptide might contribute to the immunopathology of Megaesophagus after trypanosoma cruzi infection
Human Pathology, 2013Co-Authors: Rodolfo Duarte Nascimento, Sheila Jorge Adad, Patricia Rocha Martins, Andre De Souza Lisboa, Alexandre B M Da Silveira, Debora Davila ReisAbstract:Summary Megaesophagus is one of the major causes of morbidity in chronic Chagas disease, and extensive denervation, associated with an inflammatory process, is recognized as the key factor for alterations in motility and disease development. Here, we analyzed esophagus samples from necropsied, infected individuals—6 cases with Megaesophagus and 6 cases without Megaesophagus—for the relative areas of expression of 2 neuromediators, substance P and vasoactive intestinal peptide, which are known to activate or inhibit, respectively, local immune cells. Samples from 6 noninfected individuals were used as controls. Esophageal sections were immunohistochemically stained for protein gene product 9.5, vasoactive intestinal peptide, and substance P, and the relative areas of expression of the latter 2 were calculated. Morphometric analyses revealed increased substance P and decreased vasoactive intestinal peptide relative areas in esophageal sections from patients with Megaesophagus. Furthermore, in the group of patients without Megaesophagus, the loss of vasoactive intestinal peptide positively correlated with the denervation process. We suggest that an imbalance between vasoactive intestinal peptide and substance P production results in the reestablishment and maintenance of the inflammatory process, leading to denervation and, consequently, promoting the development of Megaesophagus.
-
characterization of enteroglial cells and denervation process in chagasic patients with and without Megaesophagus
Human Pathology, 2010Co-Authors: Rodolfo Duarte Nascimento, Sheila Jorge Adad, Andre De Souza Lisboa, Alexandre B M Da Silveira, Debora Davila Reis, Ricardo Toshio Fujiwara, Michelle A R Freitas, Rodrigo Correa OliveiraAbstract:Chagas disease is caused by infestation with the parasite Trypanosoma cruzi, and some patients who are serologically positive develop chronic Megaesophagus, whereas others are symptom-free. Gastrointestinal form of Chagas disease involves an inflammatory invasion of the enteric plexuses and degeneration of enteric neurons and previous works related that enteroglial cells would be involved in enteric inflammatory responses. Because of this, the aims of this study were to determine the relation of enteroglial cells with the denervation process in chagasic patients with and without Megaesophagus and seronegative individuals. Our results indicated that the innervation of the esophageal muscle was substantially reduced in patients with Megaesophagus, but asymptomatic seropositive subjects were not different to seronegative controls. Besides, patients with Megaesophagus had significant decreased of enteroglial cells labeled with S-100 and glial fibrillary acidic protein, whereas patients without Megaesophagus presented an increased of both labels. We believe that enteroglial cells would operate a mechanism of defense in the enteric nervous system against the Trypanosoma cruzi infection, which could prevent the organ denervation and preserve the esophagus function.
-
comparative study of the presence of trypanosoma cruzi kdna inflammation and denervation in chagasic patients with and without Megaesophagus
Parasitology, 2005Co-Authors: A B M Da Silveira, R M E Arantes, Annamaria Ravara Vago, Elenice Moreira Lemos, Sheila Jorge Adad, Rodrigo Correaoliveira, Davila D ReisAbstract:Neuronal lesions have been considered the hallmark of chagasic Megaesophagus, but the role of Trypanosoma cruzi and the participation of the inflammatory cells in this process are still debated. In the present study we counted neurons in the oesophagus from patients with and without Megaesophagus and further examined these samples for the presence of parasite kDNA and cells with cytolytic potential (Natural Killer cells, cytotoxic lymphocytes and macrophages). The presence of parasite kDNA was demonstrated in 100% of cases with Megaesophagus and in 60% of patients without Megaesophagus. When analysed for the number of neurons, the patients without Megaesophagus could be classified into 2 groups, as having normal or a decreased number of neurons. The former group did not show any inflammatory process, but interestingly, all patients without Megaesophagus presenting decreased number of neurons also presented both parasite kDNA and inflammatory process in the organ. We further observed that the numbers of cytotoxic cells in the myenteric plexus region inversely correlate with the number of neurons. These data together strongly suggest that chronic lesions in chagasic Megaesophagus might be a consequence of immune-mediated mechanisms, that last until the chronic phase of infection, and are dependent on the persistence of parasite in the host's tissue.
Bruno Zilberstein - One of the best experts on this subject based on the ideXlab platform.
-
larger amounts of nitrite and nitrate reducing bacteria in Megaesophagus of chagas disease than in controls
Journal of Gastrointestinal Surgery, 2007Co-Authors: Denis Pajecki, Bruno Zilberstein, Ivan Cecconello, M Dos A Santos, Osmar Kenji Yagi, Joaquim GamarodriguesAbstract:In the Megaesophagus of Chagas’ disease, chronic esophagitis is caused by stasis of swallowed food and saliva. In this environment, the overgrowth of aerobic and anaerobic bacteria, including nitrate-reducing bacteria, is observed. The reduction of nitrate into nitrite by the action of these bacteria has been associated with the formation of volatile nitrosamines in different situations of gastric bacterial overgrowth. We have hypothesized that this phenomenon could occur in the esophageal lumen of patients with Megaesophagus. To evaluate the concentration of nitrite, the presence of volatile nitrosamines and the concentration of nitrate-reducing bacteria in the esophageal lumen of patients with nonadvanced Megaesophagus of Chagas’ disease and in a group of patients without esophageal disease. Fifteen patients with nonadvanced Megaesophagus [Megaesophagus group (MG)] and 15 patients without any esophageal disease [control group (CG)] were studied. Saliva samples were taken for nitrate and nitrite quantitative determination and esophageal stasis liquid samples were taken for nitrate and nitrite quantitative determination, volatile nitrosamines qualitative determination and reductive bacteria quantitative determination. MG and CG were equivalent in nitrate and nitrite saliva concentration and in nitrate esophageal concentration. Significant difference was found in nitrite (p = 0.003) and reductive bacteria concentration (p < 0.0001), both higher in MG. Volatile nitrosamines were identified in three MG patients and in none of the CG patients, but this was not significant (p = 0.113). There is a higher concentration of reductive bacteria in MG, responsible for the rise in nitrite concentration at the esophageal lumen and, eventually, for the formation of volatile nitrosamines.
-
lower esophageal sphincter analysis using computerized manometry in patients with chagasic Megaesophagus
Diseases of The Esophagus, 2006Co-Authors: C G Andrade, Bruno Zilberstein, Ivan Cecconello, Ary Nasi, J R Filho, P J De Campos Carvalho, Philip E Donahue, Joaquim GamarodriguesAbstract:SUMMARY. Due to the introduction of computer technology into manometry laboratories, three-dimensional manometric images of the lower esophageal sphincter can be constructed based on radially oriented pressures, a method termed ‘computerized axial manometry.’ Calculation of the sphincter pressure vector volume using this method is superior to standard manometric techniques in assessing lower esophageal sphincter function in patients with gastroesophageal reflux disease and idiopathic achalasia. Despite similarities between idiopathic achalasia and chagasic esophagopathy found using clinical, radiological, and manometric studies, controversy around lower esophageal sphincter pressure persists. The goal of this study was to analyze esophageal motor disorders in Chagas’ Megaesophagus using computerized axial manometry. Twenty patients with chagasic Megaesophagus (5 men, 15 women, and average age 50.1 years, range 17–64) were prospectively studied. For three-dimensional imaging construction of the lower esophageal sphincter, a low-complacency perfusion system and an eight-channel manometry probe with four radial channels placed in the same level were used. For probe traction, the continuous pull-through technique was used. Results showed that the lower esophageal sphincter of patients with chagasic Megaesophagus have significantly elevated pressure, length, asymmetry, and vector volumes compared to those of normal volunteers (P < 0.05). Aperistalsis of the esophageal body waves was observed in all patients and contraction amplitude was lower than that in normal patients. We conclude that patients with chagasic Megaesophagus have hypertonic lower esophageal sphincter and aperistalsis of the esophageal body.
-
pre and postoperative nutritional evaluation in patients with chagasic Megaesophagus
Nutricion Hospitalaria, 2004Co-Authors: Felix Andre Sanches Penhavel, Bruno Zilberstein, Dan Linetzky Waitzberg, Helio Ponciano Trevenzol, Leosarte Alves, Joaquim GamarodriguesAbstract:Chagasic Megaesophagus is a chronic disease that courses with progressive dysphagia, regurgitation and protein-calorie malnutrition. Advanced or recurrent Megaesophagus can be treated with Serra Doria’s operation (cardioplasty, partial gastrectomy and gastrojejunal Roux-en-Y anastomosis). A nutritional evaluation was performed on 27 patients (mean age 58 ± 10 years) with chagasic Megaesophagus at admission and after postoperative day 90. The nutritional state was assessed through global subjective nutritional evaluation (GSNE), anthropometry and laboratorial exams, besides the analysis of alimentary intake. In the preoperative period, GSNE pointed to malnutrition in 2/3 patients, while the anthropometric and laboratorial evaluation revealed that over 60% of the patients had protein-calorie malnutrition of the marasmic type. The preoperative nutritional state as evaluated by GSNE did not correlate with complications or postoperative mortality. The postoperative evaluation showed an increase in the intake of proteins, recovery in the body mass index and a reduction in the hemoglobin levels of the peripheral blood.
-
Megaesophagus microbiota a qualitative and quantitative analysis
Journal of Gastrointestinal Surgery, 2002Co-Authors: Denis Pajecki, Bruno Zilberstein, Manoel Armando Azevedo Dos Santos, Joao Ari Ubriaco, Alina Guimaraes Quintanilha, Ivan Cecconello, Joaquim GamarodriguesAbstract:Bacterial overgrowth in the esophageal lumen in patients with Megaesophagus can be the cause of recurring pulmonary infections, infectious complications due to surgical or endoscopic procedures, and the development of dysplasia of the esophageal mucosa and cancer. Despite this, esophageal microbiota in the Megaesophagus have never been studied. The aim of this study was to analyze qualitatively and quantitatively the microbiota in chagasic Megaesophagus in comparison to the normal esophagus. Twenty-five patients (10 men and 15 women), ranging in age from 24 to 74 years (mean years), were prospectively studied from March to September 2000. Fifteen patients with chagasic Megaesophagus were divided into three subgroups (n = 5 patients in each) according to the grade of esophageal dilation: MG1 = Megaesophagus grade I; MG2 = Megaesophagus grade II; and MG3 = Megaesophagus grade III. Another group of 10 patients without esophageal disease served as a control group. Samples were collected using a method especially developed to avoid contamination with microorganisms ofthe oral cavity and oropharynx. In the control group, 40% of the cultures were positive with the genus Streptococcus predominating and concentrations varying from 101 to 102 colony-forming units/ml. In the Megaesophagus group, 93.3% of the cultures were positive, with great variability in the bacteria and a predominance of various aerobic gram-positive bacteria (Streptococcus was most common) and anaerobic bacteria (Veillonella was most frequent) in concentrations that ranged from 101 to 105 colony-forming units/ml. The bacterial concentrations were generally more elevated in MG3 patients in comparison to MG1 and MG2 patients and the control group (P < 0.05). It was concluded that patients with Megaesophagus have a variety of microbiota consisting mostly of aerobic gram-positive and anaerobic bacteria, in concentrations that varied according to the degree of esophageal dilation.
-
the surgical treatment of Megaesophagus and megacolon
Digestive Diseases, 1993Co-Authors: H W Pinotti, Ivan Cecconello, Valter Nilton Felix, Angelita Habrgama, Bruno ZilbersteinAbstract:The effect of Chagas’ disease on the digestive tract is evaluated based on the experience acquired in the surgical management of 929 cases of Megaesophagus: 807 in the nonadvanced state of the disease
Ivan Cecconello - One of the best experts on this subject based on the ideXlab platform.
-
larger amounts of nitrite and nitrate reducing bacteria in Megaesophagus of chagas disease than in controls
Journal of Gastrointestinal Surgery, 2007Co-Authors: Denis Pajecki, Bruno Zilberstein, Ivan Cecconello, M Dos A Santos, Osmar Kenji Yagi, Joaquim GamarodriguesAbstract:In the Megaesophagus of Chagas’ disease, chronic esophagitis is caused by stasis of swallowed food and saliva. In this environment, the overgrowth of aerobic and anaerobic bacteria, including nitrate-reducing bacteria, is observed. The reduction of nitrate into nitrite by the action of these bacteria has been associated with the formation of volatile nitrosamines in different situations of gastric bacterial overgrowth. We have hypothesized that this phenomenon could occur in the esophageal lumen of patients with Megaesophagus. To evaluate the concentration of nitrite, the presence of volatile nitrosamines and the concentration of nitrate-reducing bacteria in the esophageal lumen of patients with nonadvanced Megaesophagus of Chagas’ disease and in a group of patients without esophageal disease. Fifteen patients with nonadvanced Megaesophagus [Megaesophagus group (MG)] and 15 patients without any esophageal disease [control group (CG)] were studied. Saliva samples were taken for nitrate and nitrite quantitative determination and esophageal stasis liquid samples were taken for nitrate and nitrite quantitative determination, volatile nitrosamines qualitative determination and reductive bacteria quantitative determination. MG and CG were equivalent in nitrate and nitrite saliva concentration and in nitrate esophageal concentration. Significant difference was found in nitrite (p = 0.003) and reductive bacteria concentration (p < 0.0001), both higher in MG. Volatile nitrosamines were identified in three MG patients and in none of the CG patients, but this was not significant (p = 0.113). There is a higher concentration of reductive bacteria in MG, responsible for the rise in nitrite concentration at the esophageal lumen and, eventually, for the formation of volatile nitrosamines.
-
lower esophageal sphincter analysis using computerized manometry in patients with chagasic Megaesophagus
Diseases of The Esophagus, 2006Co-Authors: C G Andrade, Bruno Zilberstein, Ivan Cecconello, Ary Nasi, J R Filho, P J De Campos Carvalho, Philip E Donahue, Joaquim GamarodriguesAbstract:SUMMARY. Due to the introduction of computer technology into manometry laboratories, three-dimensional manometric images of the lower esophageal sphincter can be constructed based on radially oriented pressures, a method termed ‘computerized axial manometry.’ Calculation of the sphincter pressure vector volume using this method is superior to standard manometric techniques in assessing lower esophageal sphincter function in patients with gastroesophageal reflux disease and idiopathic achalasia. Despite similarities between idiopathic achalasia and chagasic esophagopathy found using clinical, radiological, and manometric studies, controversy around lower esophageal sphincter pressure persists. The goal of this study was to analyze esophageal motor disorders in Chagas’ Megaesophagus using computerized axial manometry. Twenty patients with chagasic Megaesophagus (5 men, 15 women, and average age 50.1 years, range 17–64) were prospectively studied. For three-dimensional imaging construction of the lower esophageal sphincter, a low-complacency perfusion system and an eight-channel manometry probe with four radial channels placed in the same level were used. For probe traction, the continuous pull-through technique was used. Results showed that the lower esophageal sphincter of patients with chagasic Megaesophagus have significantly elevated pressure, length, asymmetry, and vector volumes compared to those of normal volunteers (P < 0.05). Aperistalsis of the esophageal body waves was observed in all patients and contraction amplitude was lower than that in normal patients. We conclude that patients with chagasic Megaesophagus have hypertonic lower esophageal sphincter and aperistalsis of the esophageal body.
-
Megaesophagus microbiota a qualitative and quantitative analysis
Journal of Gastrointestinal Surgery, 2002Co-Authors: Denis Pajecki, Bruno Zilberstein, Manoel Armando Azevedo Dos Santos, Joao Ari Ubriaco, Alina Guimaraes Quintanilha, Ivan Cecconello, Joaquim GamarodriguesAbstract:Bacterial overgrowth in the esophageal lumen in patients with Megaesophagus can be the cause of recurring pulmonary infections, infectious complications due to surgical or endoscopic procedures, and the development of dysplasia of the esophageal mucosa and cancer. Despite this, esophageal microbiota in the Megaesophagus have never been studied. The aim of this study was to analyze qualitatively and quantitatively the microbiota in chagasic Megaesophagus in comparison to the normal esophagus. Twenty-five patients (10 men and 15 women), ranging in age from 24 to 74 years (mean years), were prospectively studied from March to September 2000. Fifteen patients with chagasic Megaesophagus were divided into three subgroups (n = 5 patients in each) according to the grade of esophageal dilation: MG1 = Megaesophagus grade I; MG2 = Megaesophagus grade II; and MG3 = Megaesophagus grade III. Another group of 10 patients without esophageal disease served as a control group. Samples were collected using a method especially developed to avoid contamination with microorganisms ofthe oral cavity and oropharynx. In the control group, 40% of the cultures were positive with the genus Streptococcus predominating and concentrations varying from 101 to 102 colony-forming units/ml. In the Megaesophagus group, 93.3% of the cultures were positive, with great variability in the bacteria and a predominance of various aerobic gram-positive bacteria (Streptococcus was most common) and anaerobic bacteria (Veillonella was most frequent) in concentrations that ranged from 101 to 105 colony-forming units/ml. The bacterial concentrations were generally more elevated in MG3 patients in comparison to MG1 and MG2 patients and the control group (P < 0.05). It was concluded that patients with Megaesophagus have a variety of microbiota consisting mostly of aerobic gram-positive and anaerobic bacteria, in concentrations that varied according to the degree of esophageal dilation.
-
the surgical treatment of Megaesophagus and megacolon
Digestive Diseases, 1993Co-Authors: H W Pinotti, Ivan Cecconello, Valter Nilton Felix, Angelita Habrgama, Bruno ZilbersteinAbstract:The effect of Chagas’ disease on the digestive tract is evaluated based on the experience acquired in the surgical management of 929 cases of Megaesophagus: 807 in the nonadvanced state of the disease
-
surgical complications of chagas disease Megaesophagus achalasia of the pylorus and cholelithiasis
World Journal of Surgery, 1991Co-Authors: H W Pinotti, Bruno Zilberstein, Valter Nilton Felix, Ivan CecconelloAbstract:Three surgical complications of Chagas' disease—Megaesophagus, achalasia of the pylorus, and cholelithiasis—were evaluated within the framework of the experience acquired in the management of 840 cases of Megaesophagus—722 in the nonadvanced stage of the disease and 118 with advanced disease (dolichoMegaesophagus).
Fernanda Franco Munari - One of the best experts on this subject based on the ideXlab platform.
-
HPV detection within a case series of chagasic Megaesophagus associated or not with esophageal squamous cell carcinoma
2020Co-Authors: Fernanda Franco Munari, Eduardo Crema, Laura Sichero, Adriana Cruvinel-carloni, Croider Franco Lacerda, Emily Montosa Nunes, Antônio Talvane Torres De Oliveira, Cristovam Scapulatempo-neto, Sandra Regina Morini Da Silva, Sheila Jorge AdadAbstract:Abstract Background Chagasic Megaesophagus (clinical manifestation of chagasic disease) has been reported as an etiological factor for squamous cell carcinoma of the esophagus, as well as the presence of human papillomavirus (HPV). Objective We accessed the prevalence of HPV DNA in a series of squamous cell carcinomas of the esophagus associated or not with the chagasic Megaesophagus, and within samples of chagasic Megaesophagus without cancer. Data obtained was further correlated to the pathological clinical data of affected individuals. Methods Retrospective study that used a total 92 samples tissue/biopsy specimens of formalin fixed and paraffin embedded tissues were retrospectively collected from the southeast region of Brazil from patients treated in three hospitals: Barretos Cancer Hospital, Barretos, São Paulo; Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais; and São Paulo State University (UNESP), Botucatu, São Paulo. Cases were divided in three groups: i) 24 patients with chagasic Megaesophagus associated with esophageal ESCC (CM/ESCC); ii) 37 patients with esophageal ESCC without chagasic Megaesophagus (ESCC); iii) 31 patients with chagasic Megaesophagus without esophageal ESCC (CM). Results We detected a higher prevalence of high-risk HPVs in patients from both CM (12/31, 38.8%) and CM/ESCC groups (8/24, 33.3%), as compared to individuals of the ESCC group (6/37, 16.3%), although data was not statistically significant. We further observed that HPV-16 was more prevalent in patients of the ESCC (4/9, 44.5%) and CM/ESCC groups (2/8, 25.0%). In addition, some of these samples presented infection by multiple HPV types. High-risk HPVs detected were HPV-31, 45, 51, 53, 56, 66, and 73, of which the majority was identified in patients from the CM group. Furthermore, low-risk HPV-11 and HPV-70 were identified in individuals from both ESCC and CM groups. Conclusion This is the first report regarding the presence of HPV DNA in Megaesophagus associated with esophageal squamous cell carcinoma. In the present study, HPV infection appears to be directly related to the development of esophageal squamous cell carcinoma in patients with chagasic Megaesophagus. Further studies are warrantee to confirm and better understand the role of oncogenic HPV persistent infection in these patients.
-
pik3ca mutations are frequent in esophageal squamous cell carcinoma associated with chagasic Megaesophagus and are associated with a worse patient outcome
Infectious Agents and Cancer, 2018Co-Authors: Fernanda Franco Munari, Eduardo Crema, Sheila Jorge Adad, Croider Franco Lacerda, Adriana Cruvinelcarloni, Antonio Talvane Torres De Oliveira, Cristovam Scapulatemponeto, Sandra Regina Morini Da Silva, Maria Aparecida Marchesan Rodrigues, Maria Aparecida Coelho De Arruda HenryAbstract:Background Chronic diseases such as chagasic Megaesophagus (secondary to Chagas’ disease) have been suggested as etiological factors for esophageal squamous cell carcinoma; however, the molecular mechanisms involved are poorly understood.
-
the relationship between esophageal cancer chagasic Megaesophagus and hpv myths tales or reality
Histology and Histopathology, 2018Co-Authors: Fernanda Franco Munari, Adriana Cruvinel Carloni, Vania Sammartino Mariano, Kari Syrjanen, Rui Manuel Reis, Adhemar LongattofilhoAbstract:A supposed role for persistent high-risk human papillomavirus (HPV) infection in esophageal squamous cell carcinoma (ESCC) etiology has been suggested by a number of studies. Concomitantly, Megaesophagus induced by the Trypanosoma cruzi cellcycle activity also shows a potential association with ESCC. This review discusses esophageal cancer and the potential association between chagasic Megaesophagus and HPV as risk factors for ESCC development.
