What is Chagas disease (American trypanosomiasis) and how is it differentiated from achalasia?

Updated: Dec 29, 2017
  • Author: Eric A Gaumnitz, MD; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Answer

Chagas disease is an infectious disease with esophageal functioning that mimics achalasia. This condition is caused by the protozoan T cruzi, which is transmitted by a reduviid (kissing) bug bite. Chagas disease is endemic in South and Central America but has been discovered as far north as Texas. The initial manifestation is septicemia, ranging from clinically silent to life threatening; a chronic stage may then ensue. Pathophysiology reveals widespread ganglionic destruction throughout the body, involving the heart, gut, urinary tract, and respiratory tract. Clinically significant disease takes years to develop.

The most common cause of death is cardiac involvement with cardiomyopathy, conduction disturbances, and arrhythmias. Gastrointestinal tract involvement includes megaesophagus, megacolon, and megaduodenum. Esophageal involvement starts with atonic esophageal body and a nonrelaxing LES, subsequently leading to esophageal dilation. The diagnosis is confirmed by serologic testing.

Treatment of patients with esophageal Chagas disease is similar to the treatment of patients with idiopathic achalasia. Treatment is geared toward disrupting the LES. Once esophageal nerve loss has occurred, regrowth or replacement of this nerve loss is not possible. For patients with acute infection, treatment with nifurtimox and benznidazole has shown limited efficacy and has no proven efficacy in patients with chronic infection.


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