Intraesophageal balloon distension test in Chagas' disease patients with noncardiac chest pain.

Patients with Chagas' disease often have chest pain as a prominent symptom. The objective of this study was to compare the results of intraesophageal balloon distension in chagasic and nonchagasic patients with chest pain not caused by coronary obstruction. We studied 40 patients with chest pain and angiographically normal coronary arteries, 25 with a positive serologic test for Chagas' disease (Chagas group, 16 women, mean age 53+/-10 years), and 15 with a negative serologic test (control group, 11 women, mean age 46+/-10 years). All patients had radiologic and endoscopic examinations of esophagus, stomach, and duodenum, esophageal manometry with the acid infusion test in the distal esophagus, and intraesophageal balloon distension. None of them had esophageal dilation or any signs of cardiovascular disease. A 25-mm-long latex balloon located 10 cm above the lower esophageal sphincter was inflated and deflated over a period of 10 sec at 1-ml increments of air until the subjects reported chest pain or to a maximum volume of 20 mi. The test caused chest pain in 14 subjects in the control group (93%) and in 12 in the Chagas' disease group (48%, P < 0.05). The mean volume of air that caused chest pain was 10+/-3 ml in the control group and 15+/-4 ml in the Chagas' disease group (mean+/-SD, P < 0.05). The maximum intraesophageal pressure during the examination was higher in Chagas' disease patients with chest pain during balloon distension (60 +/- 21 mm Hg) than in patients who did not have chest pain (37 +/-18 mm Hg, P < 0.05) and did not differ from the control group (48+/-16 mm Hg, P > 0.05). With the other examinations there was no difference between groups or between patients with or without chest pain during the balloon distension test. Although esophagitis was observed in 47% of patients in the control group and in 40% of the Chagas' disease group, the acid infusion test was positive in 27% of patients in the control group and in 4% of patients in the Chagas' disease group. We conclude that, as compared to a group of patients with similar chest pain, chagasic patients are less sensitive to esophageal distension. Thus, it is unlikely that their chest pain is related to esophageal mechanisms.

[Esophageal origin of precordial pain in chagasic patients with normal subepicardial coronary arteries]. / Origem esofágica de dor precordial em pacientes chagásicos com artérias coronárias subepicárdicas normais.

PURPOSE: To study the chest pain of esophageal origin in chagasic patients (CH) and non-chagasic subjects (NCH) with normal coronary arteries. METHODS: The study comprised 48 patients: 33 CH (age 56 years, 50% male) and 15 NCH (age 47 years, 25 male), with precordial chest pain and normal subepicardial coronary arteries. They were assigned to upper digestive tract radiologic and endoscopic study, esophageal manometric evaluation at baseline and after provocative tests (Bernstein and intravenous edrophonium). RESULTS: Radiologic study: 14 (42%) CH and 4 (27%) NCH had esophageal dilation (p > 0.05). Hiatal hernia was documented in 7 (21%) CH and 6 (40%) NCH (p > 0.05). 2) Digestive endoscopy: In 15 (45%) CH and 6 (40%) NCH distal esophagitis were seen. In the NCH, esophagitis occurred with hiatal hernia; however only 30% of CH with esophagitis had also hiatal hernia while another 30% had esophageal dilation. 3) Esophageal motility disorders (EMD): 11 (33%) CH showed EMD: 8 with inferior esophageal sphincter achalasia (IESA) and 3 with diffuse esophageal spasm. Among NCH, 2 (13%) had IESA (p > 0.05). 4) Bernstein test--a positive test was seen in 5 (15%) CH and 3 (20%) NCH-p > 0.05. CH with esophageal dilation had 14% of positive results, while CH without esophageal dilation had 16%-p > 0.05. 5) Intravenous edrophonium-esophageal contraction amplitude enhancement provoked by the drug infusion was clearly attenuated in the chagasic (6.9 +/- 12.7 mmHg) when compared with the NCH group (18.8 +/- 21.4 mmHg). A positive test (i.e. chest pain) was obtained in only one patient who was NCH. CONCLUSION: Esophageal pain could be elicited at a relatively low and comparable rate in both groups of patients.

Análise dos achados endoscópicos e da evoluçäo de pacientes aidéticos com hemorragia deigestiva alta / Analisys of endoscopic findings and evolition of patients with AIDS and upper gastrointestinal tract hemorrhage

Este é um estudo retrospectivo dos achados endoscópicos de 27 pacientes infectados pelo HIV e que apresentaram hemorragia digestiva alta (HDA) durante o período de junho de 1988 a junho de 1992. Foi constatado que a causa mais freqüente de sangramento é a gastrite hemorrágica e nao está relacionada a infecçoes oportunísticas do tubo digestivo, mas talvez ao stress e a medicamentos usados. A HDA é condiçao pouco freqüente em aidéticos, porém, quando presente, associa-se a importante reduçao na sobrevida dos pacientes. Estudando a evoluçao desses pacientes, observou-se que 85,1 por cento faleceram num período de até nove meses após a realizaçao da endoscopia digestiva alta (EDA), sendo a HDA a causa de óbito em 56,5 por cento. A EDA é procedimento importante, pois permite localizar lesoes, diagnosticá-las, biopsiá-las, orientar a terapêutica e avaliar a evoluçao, mas parece nao alterar a sobrevida desses pacientes.

[Gastric paracoccidioidomycosis. A case report and considerations on the pathogenesis of this disease]. / Paracoccidioidomicose do estômago. Relato de caso e considerações sobre a patogenia desta lesão.

The authors report an unusual case of fungal gastric lesion in a patient with the chronic form of paracoccidioidomycosis. For a period of 8 months the major symptoms of the patient were abdominal pain and body weight loss. The endoscopic evaluation of the upper gastrointestinal tract showed a partial gastrectomy made previously, a great and irregular ulcer in the stomach and a granulated aspect of the duodenal mucosa. A granulomatous process and Paracoccidioides brasiliensis were observed in the histopathological examination of the gastric and duodenal biopsy tissue. New endoscopic evaluation 4 months after treatment with sulfadiazine revealed healing of the gastric ulcer. It was suggested that abdominal lymph nodes involvement, duodenal infection and anatomical and atrophic alterations of the stomach were predisposing factors for the gastric paracoccidioidomycosis.