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Motility disorders
Published in Michael JG Farthing, Anne B Ballinger, Drug Therapy for Gastrointestinal and Liver Diseases, 2019
There have been significant advances in the control of vectorial and transfusional transmission of this parasitosis but direct chemotherapy remains unsatisfactory. Benznidazole have been used in acute cases but its use in chronic cases is unproven. The symptomatic treatment of Chagasic megaoesophagus follows a similar approach to the treatment of achalasia (see previous text), and the treatment of Chagasic megacolon is similar to that of idiopathic megacolon (see later text).
Trypanosoma cruzi
Published in Dongyou Liu, Handbook of Foodborne Diseases, 2018
Paula Andrea Jiménez, Jesus Eduardo Jaimes, Juan David Ramírez
Other clinical manifestations may occur, such as mega viscera syndrome (megaesophagus or megacolon). As for megaesophagus, it may reveal symptoms such as dysphagia, odynophagia, epigastric pain, heartburn caused by regurgitation of gastric contents, ptyalism, and malnutrition in severe cases. Patients with this condition have a high prevalence of esophageal cancer. Megacolon usually affects the sigmoid colon, rectum, or descending colon causing intestinal obstruction, constipation, abdominal distention, and even sigmoid volvulus. In these patients, no correlation has been reported with development of colorectal cancer [46].
Lesions of the stomach
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Victoria Lane, Brice Antao, Michael S Irish
Medical treatment with continuous or night-time orogastric feeds is the first line of management. This allows the patient to grow and the stomach to enlarge, until they can tolerate normal feeds. Microgastria is usually temporised using jejunal feeds. The jejunal feedings supplement the smaller oral feedings, allowing the stomach to enlarge. If the infant’s stomach fails to enlarge, the stomach capacity can be augmented using Hunt–Lawrence’s gastric augmentation. Gastrooesophageal reflux is managed with prokinetic drugs and antireflux medications, nasojejunal feeding tubes or jejunostomy tubes. Because of the megaoesophagus and small stomach, a fundoplication is not a viable option.
Anti-neutrophil cytoplasmic antibody-positive vasculitis presenting with periaortitis and muscle vasculitis in a patient with chronic Chagas disease: comment on the letter by Garcia-Bustos et al
Published in Scandinavian Journal of Rheumatology, 2020
On the first point, we suspect that the patient was probably initially infected not during his recent trip to Bolivia but instead when he was resident there at least 15 years earlier. This aligns with the known natural history of the disease in which the chronic symptomatic forms, cardiomyopathy, megaoesophagus, and megacolon, all take 10–30 years to develop. Moreover, approximately 70% of T. cruzi seropositive individuals remain asymptomatic throughout life, and most patients, especially emigrants from Latin America, are unaware that they are infected. Of all Latin American countries, Bolivia has had the highest prevalence of Chagas disease for the past four decades (2–5). Nevertheless, since the patient presented with fever, it is possible that he was reinfected with T. cruzi during the recent trip to Bolivia. In support of this, chronically infected mice have been reported to present with exacerbated electrocardiographic symptoms, enhanced myocarditis and myositis, and increased mortality after experimental reinfection during the chronic phase (6–9).
Abstracts book
Published in Acta Clinica Belgica, 2020
A 65-year-old woman presented to the Emergency Department (ED) with severe postprandial shortness of breath, cough and increasing dyspnea. At ED presentation, her respiratory rate was 25 breaths per minute with biphasic stridor and monophonic expiratory wheezing on auscultation. The remainder of her physical examination was unremarkable. She had a past medical history significant for arterial hypertension, gastroesophageal reflux disease and breast cancer. She denied any history of dysphagia or odynophagia. A quickly performed chest radiograph showed important mediastinal widening, a right-sided paratracheal soft tissue density and lucent area in the lower chest. Chest computed tomography to evaluate the mediastinal pathology revealed marked dilatation of the esophagus measuring up to 8.1 × 7.8 cm in diameter, resulting in significant airway compression due to the mass effect of the massively dilated food-filled esophagus. For urgent esophageal decompression, a nasogastric tube was inserted and retained food was aspirated leading to complete resolution of the respiratory distress symptoms. Subsequent upper endoscopy identified no strictures or masses and confirmed the diagnosis of achalasia causing megaesophagus.
Colonic stasis and chronic constipation: Demystifying proposed risk factors for colon polyp formation in a spinal cord injury veteran population
Published in The Journal of Spinal Cord Medicine, 2018
Jason Colizzo, Jonathan Keshishian, Ambuj Kumar, Gitanjali Vidyarthi, Donald Amodeo
A number of more recent studies, however, have been unable to replicate these results; finding no significant correlation between constipation and CRC.26,27 The concept was also reviewed in Brazilian patients with Chagas disease, whose motility disturbances led to megaesophagus and megacolon. Even though an increased prevalence of esophageal squamous cell carcinoma was seen in patients with Chagas disease, a higher incidence of CRC was not observed despite the existence of colonic dilation and fecal stasis.28,29