ABSTRACTS XVI ALASBIMN CONGRESS  NUCLEAR MEDICINE 1999.

4.  GASTROENTEROLOGY

C.Q.BRANT, M.M.SEVILLANO, M.L.V.CASTIGLIONI, A.BARBIERI, G.ALONSO.

HOSPITAL SAO PAULO - UNIFESP - BRAZIL

ddi@epm.br

The injection of botulin in the lower esophagus' sphincter in patients with idiophatic megaesophagus results in improvement of clinical symptoms. There are no reports in the literature of controlled studies on the action of botulin in the megaesophagus from Chagas' disease.

OBJECTIVES: To evaluate the therapeutic effects of botulin in the Chagas' disease megasophagus.

Materials and Methods: We performed a randomized, prospective double-blind study in 14 subjects, 6 men and 8 women with megaesophagus grades II and III. The ages were between 36 to 85, with a mean age of 53.6. The subjects where clinically and nutritionally evaluated, and several tests were made like esophagogram, upper endoscopy, computadorized manometry, and cintilography with ⁹⁹Tc coloidal sulfur. They were randomized to receive either distilled water or 1.2ml doses of BOTOX (1OOU) injected into each of the four quarters of the lower esophagus sphincter. Though a clinical score (with a max. value of 16) that we used to access the degree of dysphagia, we evaluated the subjects in days 7, 30, 60, 90 and after 6 months, when we also performed a nutritional evaluation and a esophagogram. They also were subjected to manometry in day 7 and after 6 months.

Results: Until the present time, 7 of the 14 patients completed the study, 2 of them from the placebo group (GI) and 5 from the botulin group (G2). The patients from GI didn't show any clinical, manometric or cintilographic improvements after a week. The results are showed in table 1. In three patients from G2 we observed clinical, manometric and cintilographic improvements in day 7. Nutritional analysis showed medium weight gain of I Kg in patients of G2 group. There wasn't statistical difference in the inferior third of the esophagus' diameter in the esophagogram. Two patients that didn't respond to the toxin have grade III megaesophagus' and they also didn't show cintilographic or manometric respond as well.

The non-responsive group was accompanied during 90 days and subjected to conventional therapy (Myotomy or dilation)

Conclusion: There was a tendency of improvement with the injection of botulin in patients with megaesophagus grade III, that was objectively demonstrated by cintilography and manometry.

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