Home Economics American Trypanosomiasis Chagas Disease, Second Edition: One Hundred Years of Research
The association of heart disease with megaesophagus or megacolon, or both defines the cardiodigestive form of Chagas disease. In most countries the development of megaoesophagus usually precedes heart and colon disease, but the exact prevalence of the cardiodigestive form is not known because of the scarcity of appropriate studies.
Individuals with Chagas disease may be seen in two distinct phases: acute, seldom diagnosed as such, and chronic. The diagnosis of the chronic phase is based mainly on the presence of IgG antibodies against T. cruzi in patients with high suspicion of the disease or in those with a compatible clinical syndrome. Chronic Chagas infection is silent for life in more than half of the individuals. In order to define the clinical form of disease, a complete search for cardiovascular and gastrointestinal symptoms and a resting 12-lead ECG are essential. Although barium swallow and enema are needed for final diagnosis of the digestive form, these tests are usually not recommended as standard practice for patients without gastrointestinal symptoms. Asymptomatic patients with a normal ECG and no gastrointestinal tract or cardiovascular symptoms have a favorable prognosis and should be followed up every 12—24 months, since about 2% of these patients progress to a clinical form of the disease each year. There are no known markers of disease progression. Patients with ECG changes consistent with Chagas heart disease should undergo a routine cardiac assessment to establish the stage of disease. Ambulatory 24-h Holter monitoring is used to detect arrhythmias; combined chest radiography and 2D echocardiography refine the assessment of cardiac size and function, and provide additional prognosis. If complaints of dysphagia or constipation are present, the routine contrasted X-rays are indicated. Most patients can be followed by a general practitioner. Labor restrictions are limited according to the degree of heart involvement. Of note, even if a reasonable proportion of patients with Chagas heart disease die early, a similar number may have irrelevant disease until elderly ages.
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