Abnormal progression of a liquid meal through the stomach and small intestine in patients with Chagas' disease

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Abstract
This study describes the abnormal pattern of gastrointestinal progression of a liquid meal in patients with the digestive form of chronic Chagas' disease. This condition is known as a natural model of intramural denervation of the gut. Sixteen patients with clinical and radiographic evidence of esophageal and/or colonic involvement and 18 healthy volunteers were studied. Orocecal transit time after the ingestion of a 10% lactulose solution (180 ml) tagged with99mtechnetium was measured by a conventional H2 breath technique. Gastric emptying and the arrival of the front of the meal to regions of interest corresponding to proximal and distal areas of the small intestine were assessed by abdominal scintigraphy. Orocecal transit time was significantly greater (P<0.05) in Chagas' disease patients (N=13) than in control subjects (N=18) (mean±sd: 100.7±48.7 min vs 62.9 ±18.2 min). Half-time for gastric emptying of liquids in chagasic patients (N=9) was significantly lower (P<0.01) than in controls (N=7) (9.7±2.7 min vs 26.4±3.4 min). The time of arrival of the liquid meal to the proximal small intestine was also significantly shorter (P0.05). These results indicate that patients with Chagas' disease have a combination of exceedingly rapid gastric emptying and abnormally delayed transit of liquids through the more distal segments of the small bowel. These abnormalities are likely to be a consequence of gut intramural denervation and emphasize the complex modulatory role of the enteric nervous system in gastrointestinal transit regulation.