Chagas gastrointestinal disease
- Rogelio Lopez-Velez, MD, DTMH, PhD
Rogelio Lopez-Velez, MD, DTMH, PhD
- Associate Professor
- Alcala University
- National Referral Unit for Tropical Diseases, Infectious Diseases Department
- Ramón y Cajal University Hospital, Madrid, Spain
Chagas disease is caused by the protozoan parasite Trypanosoma cruzi, which is most commonly transmitted by triatomine bugs. The major manifestations are Chagas cardiomyopathy and gastrointestinal disease.
Issues related to Chagas gastrointestinal disease will be reviewed here. Other issues related to Chagas disease, including cardiac disease, epidemiology, diagnosis, and treatment, are discussed in detail separately. (See related topics.)
Gastrointestinal manifestations are the second most common cause of complications due to Chagas disease. The mortality is low, but symptoms can have a considerable impact on quality of life. The digestive form is seen more frequently in the countries of the Southern Cone of South America (a high prevalence has been observed in the central region of Brazil) and is rare in northern South America, Central America, and Mexico . This geographic pattern is thought to be due to distribution of different T cruzi genotypes (DTUs) .
Among individuals with the chronic indeterminate form of Chagas disease, approximately 20 to 30 percent progress over a period of 10 to 30 years to clinically evident cardiac involvement, digestive involvement, or both. The likelihood of cardiac or digestive involvement may vary by region . In the Amazon region, up to 15 to 20 percent of patients with chronic Chagas disease develop digestive involvement ; this figure is similar to that observed among immigrants from Bolivia to nonendemic areas .
Both parasite and host factors are thought to influence the development of gastrointestinal manifestations and the severity of disease. Molecular techniques have demonstrated the presence of parasite DNA in digestive tissues, which correlates with inflammatory infiltrate and degree of denervation . The occurrence of the gastrointestinal manifestations in areas south of the Amazon basin has been attributed to variations in parasite strains .
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- CLINICAL MANIFESTATIONS
- Esophageal manifestations
- Colonic manifestations
- Other manifestations
- Clinical approach
- Esophageal involvement
- - Radiography
- - Manometry
- - Endoscopy
- Colonic involvement
- - Radiography
- - Manometry
- - Endoscopy
- - Abdominal ultrasound
- Differential diagnosis
- INFORMATION FOR PATIENTS