Scintigraphic study of the gastrointestinal transit of a liquid meal in patients with chronic chagas'disease

ABSTRACT

Gastric emptying and small bowel transit of a liquid meal (sotonic dextrose) were assessed by a scintigraphic technique in 16 patients with Chagas'disease involving the esophagus and/or the colon, including one case with megajejunum, and in 10 control subjects. Initial gastric emptying was faster in the Chagas'disease group than in controls (gastric retention at 15 min, median and (range): 52% (15-86) vs 71% (43-97), P<0.01) although there was no significant difference in total gastric emptying (T1/2:20 min (4-132) vs 31 min (13-280), P>0.05). Both the front (time to reach the proximal small bowel: 2.5 min (2.5-8) vs 15 min (5-40), P<0.01) and the bulk of the meal (geometric center values at 15 min:1.8(1.2-2.4) vs 1.6(1.2-1.8), P<0.05) travelled faster through the proximal small bowel in Chagas'disease patients than in control subjects. There was no difference between the two groups concerning the time taken by the front of the meal to arrive to the caecum (110 min (15-180) vs 90 min (60-140), P>0.20), but a precise delineation of this region was possible in only less than half of the patients and controls. in the patient with megajujunum, a remarkable delay in the intestinal progression of the liquid meal was found. These results suggest that the diffuse lesion of the enteric nervous system in chronic Chagas'disease mainly affects the controlnof gastric emptying and leads to accelerated proximal small bowel transit of a liquid meal. Impairment of the intestinal progression of the liquid meal seems to occur only inn assocaition of the small bowel