sincalide and Esophageal-Achalasia

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

Malignancies involving the gastric cardia or distal esophagus can result in a clinical syndrome termed pseudoachalasisa that mimics idiopathic achalasia. If not promptly recognized, pseudoachalasia can result in inappropriate pneumatic dilatation of the lower esophageal sphincter segment and delay appropriate treatment of the underlying malignancy. During the past 14 years, six patients with pseudoachalasia and 161 patients with primary idiopathic achalasia were encountered. Pseudoachalasia occurred mainly in the elderly and represented about 9 percent of these patients over 60 years of age with suspected achalasia. Five of the six pseudoachalasia cases were secondary to adenocarcinoma that originated in the gastric fundus, and one was caused by a squamous cell carcinoma of the distal esophagus. Conventional esophageal manometry did not discriminate achalasia from pseudoachalasia. On the other hand, esophagogastroscopy with biopsy resulted in a diagnosis of pseudoachalasia in five of these cases and in 24 of 32 cases reported previously. Ominous endoscopic findings are mucosal ulceration or nodularity, reduced compliance of the esophagogastric junction, or an inability to pass the endoscope into the stomach. Radiographic evaluation, particularly in conjunction with amyl nitrite inhalation, was also useful in discriminating pseudoachalasia from primary achalasia. It is concluded that pseudoachalasia generally mimics idiopathic achalasia imperfectly and can usually be diagnosed prior to surgery by fastidious endoscopic and radiographic examination.

Topics: Adult; Aged; Diagnosis, Differential; Esophageal Achalasia; Esophagogastric Junction; Esophagoscopy; Gastroscopy; Humans; Manometry; Methacholine Chloride; Methacholine Compounds; Middle Aged; Peristalsis; Radiography; Sincalide; Syndrome

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