sincalide and Chagas-Disease

Gallbladder motor function was evaluated in 21 Chagasic patients with megacolon and/or megaesophagus and the results were compared with those obtained in 19 control subjects. Gallbladder contraction was evaluated by the radiologic method after the application of two different stimuli: an exogenous one consisting of intravenous injection of cholecystokinin octapeptide at the dose of 30 ng/kg over a period of 1 min, radiologic evaluation was performed before and 5, 10, 15 and 20 min after the stimulus; an endogenous one produced by standardised intraduodenal instillation of a lipid emulsion, radiologic evaluation was performed before and 3, 5, 10, 15, 20, 25 and 30 min after the beginning of intraduodenal infusion. The gallbladder of the Chagasic patients was found to be hypersensitive to both stimuli, since it contracted in a statistically more intense manner, with contraction starting earlier and lasting longer than among the controls. This difference in contracting behavior suggests impairment of the inhibitory intrinsic innervation of the gallbladder.

Topics: Adolescent; Adult; Chagas Disease; Dietary Fats; Esophageal Achalasia; Female; Gallbladder; Humans; Male; Megacolon; Middle Aged; Muscle Contraction; Sincalide; Stimulation, Chemical

The motility of the sigmoid colon and rectum was studied by manometry in patients with Chagasic megacolon and in control individuals using two different experimental procedures: (1) intravenous infusion of saline, followed by intravenous infusion of cholecystokinin octapeptide (OP-CCK) at the dose of 20 ng/kg/hr; and (2) intraduodenal instillation of saline followed by a solution of essential amino acids at a flow of 10 ml/min. CCK-OP induced an increase in motility index in the sigmoid colon (P less than 0.05) and rectum (P less than 0.05) in the controls, whereas intraduodenal infusion of amino acids produced a significant increase in motility index exclusively in the sigmoid colon (P less than 0.005). A significant increase (P less than 0.05) in sigmoid colon motility also occurred in the control group after duodenal saline infusion was interrupted. The release of other substances in addition to CCK must have been responsible for the different behavior of sigmoid colon and rectum in response to the stimuli used. Neither procedure caused significant changes in the motility of the sigmoid colon or the rectum of the Chagasic patients. The extensive intramural denervation occurring in Chagasic megacolon probably destroys the neural pathway through which OP-CCK and the substances released by the duodenum by the infusion of essential amino acids activate the motor cells of the human terminal intestine.

Topics: Adult; Amino Acids, Essential; Chagas Disease; Colon, Sigmoid; Female; Gastrointestinal Motility; Humans; Male; Manometry; Megacolon; Middle Aged; Myenteric Plexus; Pressure; Rectum; Sincalide; Sodium Chloride

Autonomic denervation is found throughout the entire length of the digestive tract in Chagas' disease. Anatomic evidence of myenteric ganglia reduction in chagasic gallbladders has been noted; however, the sphincter of Oddi has not been studied. The purpose of this study is twofold: first, to determine sphincter of Oddi pressure in 11 patients with chronic Chagas' disease and megaesophagus, and to compare the results with those obtained in 27 control subjects; and second, to evaluate the effect of cholecystokinin-octapeptide on sphincter of Oddi pressure in both groups of patients. Sphincter of Oddi pressure was recorded continuously via an endoscopically placed triple-lumen catheter inserted into the papilla and directed into the common bile duct. Basal sphincter of Oddi pressure was 12.9 +/- 1.1 mmHg in controls as compared with 44.9 +/- 4.7 mmHg in chagasics with megaesophagus. Mean common bile duct/duodenum gradient pressure was 4.1 +/- 2.4 mmHg in controls as compared with 13.1 +/- 2.7 mmHg in chagasics. Amplitude of sphincter of Oddi phasic contractions in the control group was 102.4 +/- 5.5 mmHg as compared with 140.5 +/- 9.2 mmHg in the chagasic group. Pulse dose of intravenous cholecystokinin-octapeptide produced a decrease of basal sphincter of Oddi pressure with inhibition of sphincter of Oddi phasic contractions in both chagasic and control patients. In chagasic patients, a neural abnormality in the sphincter of Oddi segment could explain the observed high basal pressure and high amplitude of phasic contractions. Chagasic patients with sphincter of Oddi pressure abnormalities, demonstrating sphincter of Oddi relaxation after cholecystokinin-octapeptide, may have neural impairment limited to preganglionic fibers, while the postganglionic inhibitory nerves remain at least partially intact.

Topics: Adolescent; Adult; Ampulla of Vater; Chagas Disease; Cholecystokinin; Common Bile Duct; Esophageal Achalasia; Female; Humans; Male; Manometry; Middle Aged; Peptide Fragments; Pressure; Sincalide; Sphincter of Oddi