Isosorbide and nifedipine for Chagas' megaesophagus: A systematic review and meta-analysis

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Chagas disease 32 infectiousdiseases
trypanosomiasis 1 infectiousdiseases

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Chagas disease 1724 UNITED STATESPublication date (epub): 9/2018Publication date (collection): 9/2018AbstractBackground Chagas disease is a neglected tropical disease. About 6 to 8 million people are chronically infected and 10% to 15%
Chagas disease 3923 profile.Trial registrationPROSPERO CRD42017055143.ClinicalTrials.gov CRD42017055143.SummaryAuthor summary Chagas disease is a chronic neglected tropical disease that has increased in prevalence in the last decade. About 10%
Chagas disease 4847 ingestion. In light of this, both medications are effective in the treatment of symptoms associated with Chagas disease . Isosorbide appears to be more effective, and its use is supported by a larger number of studies; nifedipine,
Chagas disease 5253 AvailabilityAll relevant data are within the paper and its Supporting Information files.Introduction Chagas disease , also known as American trypanosomiasis, is an infectious zoonosis caused by the protozoan parasite
Chagas disease 5739 relevance, it is considered by the World Health Organization a neglected tropical disease [[1], [2]]. Chagas disease is transmitted by triatomine vectors (popularly known as kissing bugs), vertically (from mother to fetus),
Chagas disease 6359 patients remain asymptomatic, but approximately 30% of infected people develop medical complications from Chagas disease over the course of their lives, usually several years or even decades after the initial infection. The
Chagas disease 6623 system, and nervous system [[3], [4]].Digestive disorders are the second most common manifestation of Chagas disease , affecting about 10% to 15% of patients [[5]]. There are geographical variations in the prevalence and
Chagas disease 7415 the first affected organ and megaesophagus is the most prevalent manifestation of gastrointestinal Chagas disease [[6], [9]]. The most common symptoms of megaesophagus are dysphagia, odynophagia, and esophageal regurgitation.
Chagas disease 8042 1.10.1371/journal.pntd.0006836.t001Table 1Clinical characteristics of Chagas’ megaesophagus.Prevalence [[2], [5], [11]]Chronic Chagas disease : 6 to 8 million patients worldwide.Digestive form: 10 to 15% of chronic patients.In endemic regions,
Chagas disease 8190 worldwide.Digestive form: 10 to 15% of chronic patients.In endemic regions, about 7 to 10% of patients with Chagas disease present radiologic evidence of esophageal disorders and 3% present dilated esophagus.Pathophysiology
Chagas disease 9477 of digestive manifestations. These medications may be used to prevent other complications of chronic Chagas disease , such as cardiovascular manifestations.Symptomatic treatment [[5], [13]]• Nutritional modifications:
Chagas disease 11474 [[6], [18]]. Only a few small studies have evaluated the use of these medications in patients with Chagas disease , and there is no systematic review on this topic. Therefore, the objective of this systematic review
Chagas disease 11706 the effectiveness of isosorbide and nifedipine versus no treatment for esophageal manifestations of Chagas disease in adult patients and to determine the frequency of side effects.MethodsProtocol and registrationThis
Chagas disease 12614 independent searches, one for each intervention (isosorbide and nifedipine). Search terms included “ Chagas disease ”, “Trypanosoma cruzi”, “isosorbide”, and “nifedipine”. Keywords related to outcomes of
Chagas disease 13257 effects of isosorbide or nifedipine on esophageal symptoms or esophageal function in patients with Chagas disease ; and (C) individuals aged >18 years with digestive or cardiodigestive form of Chagas disease, according
Chagas disease 13350 patients with Chagas disease; and (C) individuals aged >18 years with digestive or cardiodigestive form of Chagas disease , according to original studies definitions. We excluded reviews, letters, and editorials.The outcomes
Chagas disease 13690 esophageal emptying), and (C) adverse events. We did not include other gastrointestinal symptoms caused by Chagas disease , because isosorbide and nifedipine are used only for esophageal symptoms.Study selection and data extractionIn
Chagas disease 23318 versus placebo on the frequency and severity of dysphagia and global well-being in 23 patients with Chagas disease . Patients took both isosorbide and placebo, for 1 week each, in a randomly allocated order. During the
Chagas disease 24897 pressure (LESP)Only one before-after study evaluated the effect of nifedipine on LESP in patients with Chagas disease [[31]]. Dantas et al. (1986) reported a decrease in LESP 35 minutes after nifedipine administration,
Chagas disease 25140 about 20 minutes. However, this effect was not present in all patients: four out of 15 patients with Chagas disease showed no changes in LESP. The quality of evidence was rated as very low due to the high risk of bias
Chagas disease 25415 emptyingFigueiredo et al. (1992) [[34]] assessed the effect of nifedipine on esophageal emptying in 11 patients with Chagas disease using a scintigraphic technique. There was no difference between food retention under basal conditions
Chagas disease 26152 administration.DiscussionThis review evaluated the effect of isosorbide and nifedipine on esophageal symptoms in patients with Chagas disease . Studies investigating the effect of isosorbide showed that this medication decreased LESP and esophageal
Chagas disease 26957 reported by about 10% of patients.Even though digestive symptoms are a well-known manifestation of Chagas disease , recommendations for their treatment are often neglected. In a review of published guidelines for the
Chagas disease 27088 for their treatment are often neglected. In a review of published guidelines for the management of Chagas disease , 10 documents were found, but only two of them provided recommendations for the pharmacological treatment
Chagas disease 28299 side effects of nifedipine was lower, a result similar to that reported in studies of patients without Chagas disease [[38], [39]]. Although nifedipine is usually better tolerated, it should be avoided in patients with
Chagas disease 28464 better tolerated, it should be avoided in patients with severe cardiomyopathy, a common manifestation of Chagas disease , due to the risk of hypotension and hydrosaline retention.To our knowledge, this is the first systematic
Chagas disease 28661 is the first systematic review to evaluate the effects of isosorbide and nifedipine in patients with Chagas disease . We performed a comprehensive literature search without language or date restrictions and systematically
Chagas disease 29576 may limit generalizability of the findings, which may be an issue of concern especially nowadays when Chagas disease has spread globally. Moreover, the studies were conducted at least 23 years ago, and since then the
Chagas disease 30309 unknown. It is important to note that our systematic review evaluated only studies of patients with Chagas disease ; for the assessment of side effects, we did not include information from further studies conducted in
Chagas disease 30520 conducted in other relevant fields, such as cardiology. Although including the results of patients without Chagas disease would increase the heterogeneity and indirectness of our findings, it could give more precision to the
Chagas disease 30729 precision to the prevalence estimates of some side effects that may be similar in patients with and without Chagas disease .Based on the findings of our systematic review, while also acknowledging the lack of rigorous studies
Chagas disease 30970 clinical trials, isosorbide and nifedipine are effective in the treatment of esophageal manifestations of Chagas disease . Isosorbide appears to be more effective, and its use is supported by a larger number of studies. However,
trypanosomiasis 5292 within the paper and its Supporting Information files.IntroductionChagas disease, also known as American trypanosomiasis , is an infectious zoonosis caused by the protozoan parasite Trypanosoma cruzi. Once confined to Latin

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