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      The Chronic Gastrointestinal Manifestations of Chagas Disease

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          Abstract

          Chagas disease is an infectious disease caused by the protozoan Trypanosoma cruzi. The disease mainly affects the nervous system, digestive system and heart. The objective of this review is to revise the literature and summarize the main chronic gastrointestinal manifestations of Chagas disease. The chronic gastrointestinal manifestations of Chagas disease are mainly a result of enteric nervous system impairment caused by T. cruzi infection. The anatomical locations most commonly described to be affected by Chagas disease are salivary glands, esophagus, lower esophageal sphincter, stomach, small intestine, colon, gallbladder and biliary tree. Chagas disease has also been studied in association with Helicobacter pylori infection, interstitial cells of Cajal and the incidence of gastrointestinal cancer.

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          Evaluation and treatment of chagas disease in the United States: a systematic review.

          Caryn Bern, Susan P. Montgomery, Barbara Herwaldt … (2007)
          Because of population migration from endemic areas and newly instituted blood bank screening, US clinicians are likely to see an increasing number of patients with suspected or confirmed chronic Trypanosoma cruzi infection (Chagas disease). To examine the evidence base and provide practical recommendations for evaluation, counseling, and etiologic treatment of patients with chronic T cruzi infection. Evidence Acquisition Literature review conducted based on a systematic MEDLINE search for all available years through 2007; review of additional articles, reports, and book chapters; and input from experts in the field. The patient newly diagnosed with Chagas disease should undergo a medical history, physical examination, and resting 12-lead electrocardiogram (ECG) with a 30-second lead II rhythm strip. If this evaluation is normal, no further testing is indicated; history, physical examination, and ECG should be repeated annually. If findings suggest Chagas heart disease, a comprehensive cardiac evaluation, including 24-hour ambulatory ECG monitoring, echocardiography, and exercise testing, is recommended. If gastrointestinal tract symptoms are present, barium contrast studies should be performed. Antitrypanosomal treatment is recommended for all cases of acute and congenital Chagas disease, reactivated infection, and chronic T cruzi infection in individuals 18 years or younger. In adults aged 19 to 50 years without advanced heart disease, etiologic treatment may slow development and progression of cardiomyopathy and should generally be offered; treatment is considered optional for those older than 50 years. Individualized treatment decisions for adults should balance the potential benefit, prolonged course, and frequent adverse effects of the drugs. Strong consideration should be given to treatment of previously untreated patients with human immunodeficiency virus infection or those expecting to undergo organ transplantation. Chagas disease presents an increasing challenge for clinicians in the United States. Despite gaps in the evidence base, current knowledge is sufficient to make practical recommendations to guide appropriate evaluation, management, and etiologic treatment of Chagas disease.
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            Association of Helicobacter pylori infection with gastric carcinoma: a meta-analysis.

            G D Eslick, L L Lim, J E Byles … (1999)
            As conflicting studies have recently been published, we aimed to determine if Helicobacter pylori (H. pylori) infection is associated with gastric adenocarcinoma. This was a meta-analysis of observational epidemiological studies. A total of 42 studies met the selection criteria and were categorized by the type of study design: eight cohort and 34 case-control studies. The pooled odds ratio for H. pylori in relation to gastric carcinoma was 2.04 (95% CI: 1.69-2.45). Both patient age (OR 0.77, 95% CI: 0.68-0.89) and intestinal type cancers (OR 1.14, 95% CI: 1.05-1.25) were independent effect modifiers. Analysis of other effect modifiers showed no relationship with female gender (OR 0.76, 95% CI: 0.64-0.89), stage of cancer (advanced %) (OR 1.12, 95% CI: 0.88-1.43), anatomical location (cardia %) (OR 1.54, 95% CI: 0.32-7.39) or cohort (nested case-control) studies (OR 1.72, 95% CI: 0.32-9.17). There was significant heterogeneity among the studies (tau2 = 149; p < 0.001). The quality of the studies varied considerably, with the majority of excellent studies producing positive results and the very poor to moderate studies producing mixed results. H. pylori infection is associated with a 2-fold increased risk of developing gastric adenocarcinoma.
            Article 0 comments Cited 73 times – based on 0 reviews     Review now
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              Chagas' disease and Chagas' syndromes: the pathology of American trypanosomiasis.

              F Köberle (1967)
              Article 0 comments Cited 72 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clinics (Sao Paulo)
                Title: Clinics
                Publisher: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
                ISSN (Print): 1807-5932
                ISSN (Electronic): 1980-5322
                Publication date (Print): December 2009
                Volume: 64
                Issue: 12
                Pages: 1219-1224
                Affiliations
                [I ] Departamento de Anatomia e Cirurgia, Universidade de São Paulo - Ribeirão Preto/SP, Brazil
                [II ] Department of Physiology and Biomedical Engineering, Mayo Clinic - Rochester/Minnesota, USA.
                Author notes
                Email: nmmatsuda@ 123456uol.com.br Tel: 55 16 3633.0836
                Article
                Publisher ID: cln_64p1219
                DOI: 10.1590/S1807-59322009001200013
                PMC ID: 2797592
                PubMed ID: 20037711
                SO-VID: cedd4b39-6321-441f-ba8f-336a5cee35b3
                Copyright © Copyright © 2009 Hospital das Clínicas da FMUSP
                History
                Date received : 27 August 2009
                Date accepted : 18 September 2009
                Categories
                Subject: Review

                ScienceOpen disciplines: Medicine
                Keywords: enteric nervous system,motility disorders,gastrointestinal tract,chagas disease, trypanosoma cruzi
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: enteric nervous system, motility disorders, gastrointestinal tract, chagas disease, trypanosoma cruzi

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