The Spectrum of Esophageal Dismotility in Chagas Disease on High-Resolution Esophageal Manometry As Defined By Chicago Classification V4.0

BACKGROUND: Esophageal motor patterns associated with Chagas disease (CD) have been examined in several high-resolution esophageal manometry (HREM) studies involving cohorts with varying characteristics and outcomes. None of these studies applied the Chicago Classification v4.0 (CCv4.0). GOALS: This study aimed to identify the spectrum of esophageal motor disorders related to CD based on the criteria outlined in CCv4.0. STUDY: The study included 129 patients with positive serologic tests for CD and no anatomic obstructive lesions, referred to HREM from identified sources. The HREM plots were retrieved and reanalyzed according to CCv4.0. Motor responses to multiple rapid swallows (MRS) were included in the analysis. The electronic medical records were scrutinized for demographic, medical, and radiographic data. RESULTS: Achalasia was the most frequent pattern (32.6%), followed by normal (23.2%), absent contractility (AC) (16.3%), inconclusive esophagogastric junction outflow obstruction (EGJOO) (12.4%), ineffective esophageal motility (IEM) (12.4%) and conclusive EGJOO (2.3%). Diagnostic profiles varied by referral source. Among patients with obstructive symptoms, 44% had achalasia, 17% AC, 13% normal, 12% IEM, 10% inconclusive EGJOO, and 3% conclusive EGJOO. MRS motor responses in CD varied among different esophageal motor patterns. Sitting MRS-IRP was abnormal in 35% of patients with AC. CONCLUSIONS: On the basis of CCv4.0 criteria, achalasia is identified in nearly half of individuals with CD, whereas normal and hypocontractile motility patterns are present in a substantial proportion of cases. Differences in manometric patterns according to the source of referral clarify discrepancies found in earlier studies.