Abstract
Chagas’ disease (CD) is highly prevalent in South America; however, the United States and a number of non-endemic countries in Europe and Western Pacific Region have experienced a considerable increase in number of T. cruzi-infected individuals, especially due to migration of people from endemic countries. The disease is caused by the protozoan Trypanossoma cruzy, a flagellated protozoan that is transmitted to humans by a blood-sucking insect. CD is a disease similar to idiopathic achalasia, although esophageal dilatation is more pronounced in CD. Preoperative evaluation, endoscopic treatment (forceful dilatation and botulinum toxin injection), Heller’s myotomy, esophagectomy, conservative techniques other than myotomy, are reviewed. Nonadvanced achalasia is frequently treated by Heller’s myotomy. Endoscopic treatment is reserved to limited cases. Treatment for end-stage achalasia is not unanimous. Esophagectomy was a popular treatment in advanced disease; however, the morbidity/mortality associated to the procedure made some authors seek different alternatives, such as Heller's myotomy and cardioplasties. Minimally invasive approach to esophageal resection may change this concept, although few centers perform the procedure routinely.
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