Agreement between upper endoscopy and esophagography in the diagnosis of megaesophagus in Chagas disease

Agreement between upper endoscopy and esophagography in the diagnosis of megaesophagus in Chagas disease

Abstract INTRODUCTION The diagnosis and classification of megaesophagus can be challenging in patients with Chagas disease. The present study aimed to evaluate the agreement between upper endoscopies and esophagographies for the diagnosis and classification of megaesophagus in Chagas disease. METHODS: A cross-sectional study of 50 patients with Chagas disease with upper digestive symptoms was undertaken. Esophagography and upper endoscopy exams were performed to compare diagnoses. Statistical analysis included sensitivity and specificity used to evaluate the diagnostic accuracy of upper endoscopies, and measures of agreement: linearly weighted Kappa (κw) and Cohen`s classical Kappa (κ) coefficients with 95% confidence intervals (95% CI). RESULTS: Twenty-three patients (46%) were diagnosed with megaesophagus by esophagography. The upper endoscopy sensitivity and specificity for megaesophagus diagnosis were 100% and 33.3%, respectively. Regarding megaesophagus classifications, there was a substantial agreement between the two exams (κw = 0.622; 95% CI: 0.498 to 0.746). Within megaesophagus groups, agreement for group I was slight (κ = 0.096; 95% CI: 0.000 to 0.403); for group II, substantial (κ = 0.703; 95% CI: 0.456 to 0.950); and for groups III and IV, inconclusive (κ = 0.457; 95% CI: 0.000 to 0.967; κ = 0.540; 95% CI: 0.035 to 1.000, respectively). CONCLUSIONS Upper endoscopy has a high sensitivity, but a low specificity to diagnose megaesophagus. Agreement between the two exams varies depending on the megaesophagus grade. Thus, upper endoscopy can be used in the diagnostic workup of a possible Chagas disease megaesophagus, but all identified cases should undergo esophagography.

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Main Authors: Barros,Fernando de, Soares,João Carlos de Almeida, Barros,Fernando Prado de, Sangenis,Luiz Henrique Conde, Silva,Gilberto Marcelo Sperandio da, Fonseca,Ana Beatriz Monteiro, Hasslocher-Moreno,Alejandro Marcel, Sousa,Andrea Silvestre de, Saraiva,Roberto Magalhães, Mediano,Mauro Felippe Felix
Format: Digital revista
Language:English
Published: Sociedade Brasileira de Medicina Tropical - SBMT 2019
Online Access:http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822019000100309
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spelling oai:scielo:S0037-868220190001003092019-03-01Agreement between upper endoscopy and esophagography in the diagnosis of megaesophagus in Chagas diseaseBarros,Fernando deSoares,João Carlos de AlmeidaBarros,Fernando Prado deSangenis,Luiz Henrique CondeSilva,Gilberto Marcelo Sperandio daFonseca,Ana Beatriz MonteiroHasslocher-Moreno,Alejandro MarcelSousa,Andrea Silvestre deSaraiva,Roberto MagalhãesMediano,Mauro Felippe Felix Esophageal achalasia Chagas disease Esophageal motility disorder Abstract INTRODUCTION The diagnosis and classification of megaesophagus can be challenging in patients with Chagas disease. The present study aimed to evaluate the agreement between upper endoscopies and esophagographies for the diagnosis and classification of megaesophagus in Chagas disease. METHODS: A cross-sectional study of 50 patients with Chagas disease with upper digestive symptoms was undertaken. Esophagography and upper endoscopy exams were performed to compare diagnoses. Statistical analysis included sensitivity and specificity used to evaluate the diagnostic accuracy of upper endoscopies, and measures of agreement: linearly weighted Kappa (κw) and Cohen`s classical Kappa (κ) coefficients with 95% confidence intervals (95% CI). RESULTS: Twenty-three patients (46%) were diagnosed with megaesophagus by esophagography. The upper endoscopy sensitivity and specificity for megaesophagus diagnosis were 100% and 33.3%, respectively. Regarding megaesophagus classifications, there was a substantial agreement between the two exams (κw = 0.622; 95% CI: 0.498 to 0.746). Within megaesophagus groups, agreement for group I was slight (κ = 0.096; 95% CI: 0.000 to 0.403); for group II, substantial (κ = 0.703; 95% CI: 0.456 to 0.950); and for groups III and IV, inconclusive (κ = 0.457; 95% CI: 0.000 to 0.967; κ = 0.540; 95% CI: 0.035 to 1.000, respectively). CONCLUSIONS Upper endoscopy has a high sensitivity, but a low specificity to diagnose megaesophagus. Agreement between the two exams varies depending on the megaesophagus grade. Thus, upper endoscopy can be used in the diagnostic workup of a possible Chagas disease megaesophagus, but all identified cases should undergo esophagography.info:eu-repo/semantics/openAccessSociedade Brasileira de Medicina Tropical - SBMTRevista da Sociedade Brasileira de Medicina Tropical v.52 20192019-01-01info:eu-repo/semantics/articletext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822019000100309en10.1590/0037-8682-0258-2018
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country Brasil
countrycode BR
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region America del Sur
libraryname SciELO
language English
format Digital
author Barros,Fernando de
Soares,João Carlos de Almeida
Barros,Fernando Prado de
Sangenis,Luiz Henrique Conde
Silva,Gilberto Marcelo Sperandio da
Fonseca,Ana Beatriz Monteiro
Hasslocher-Moreno,Alejandro Marcel
Sousa,Andrea Silvestre de
Saraiva,Roberto Magalhães
Mediano,Mauro Felippe Felix
spellingShingle Barros,Fernando de
Soares,João Carlos de Almeida
Barros,Fernando Prado de
Sangenis,Luiz Henrique Conde
Silva,Gilberto Marcelo Sperandio da
Fonseca,Ana Beatriz Monteiro
Hasslocher-Moreno,Alejandro Marcel
Sousa,Andrea Silvestre de
Saraiva,Roberto Magalhães
Mediano,Mauro Felippe Felix
Agreement between upper endoscopy and esophagography in the diagnosis of megaesophagus in Chagas disease
author_facet Barros,Fernando de
Soares,João Carlos de Almeida
Barros,Fernando Prado de
Sangenis,Luiz Henrique Conde
Silva,Gilberto Marcelo Sperandio da
Fonseca,Ana Beatriz Monteiro
Hasslocher-Moreno,Alejandro Marcel
Sousa,Andrea Silvestre de
Saraiva,Roberto Magalhães
Mediano,Mauro Felippe Felix
author_sort Barros,Fernando de
title Agreement between upper endoscopy and esophagography in the diagnosis of megaesophagus in Chagas disease
title_short Agreement between upper endoscopy and esophagography in the diagnosis of megaesophagus in Chagas disease
title_full Agreement between upper endoscopy and esophagography in the diagnosis of megaesophagus in Chagas disease
title_fullStr Agreement between upper endoscopy and esophagography in the diagnosis of megaesophagus in Chagas disease
title_full_unstemmed Agreement between upper endoscopy and esophagography in the diagnosis of megaesophagus in Chagas disease
title_sort agreement between upper endoscopy and esophagography in the diagnosis of megaesophagus in chagas disease
description Abstract INTRODUCTION The diagnosis and classification of megaesophagus can be challenging in patients with Chagas disease. The present study aimed to evaluate the agreement between upper endoscopies and esophagographies for the diagnosis and classification of megaesophagus in Chagas disease. METHODS: A cross-sectional study of 50 patients with Chagas disease with upper digestive symptoms was undertaken. Esophagography and upper endoscopy exams were performed to compare diagnoses. Statistical analysis included sensitivity and specificity used to evaluate the diagnostic accuracy of upper endoscopies, and measures of agreement: linearly weighted Kappa (κw) and Cohen`s classical Kappa (κ) coefficients with 95% confidence intervals (95% CI). RESULTS: Twenty-three patients (46%) were diagnosed with megaesophagus by esophagography. The upper endoscopy sensitivity and specificity for megaesophagus diagnosis were 100% and 33.3%, respectively. Regarding megaesophagus classifications, there was a substantial agreement between the two exams (κw = 0.622; 95% CI: 0.498 to 0.746). Within megaesophagus groups, agreement for group I was slight (κ = 0.096; 95% CI: 0.000 to 0.403); for group II, substantial (κ = 0.703; 95% CI: 0.456 to 0.950); and for groups III and IV, inconclusive (κ = 0.457; 95% CI: 0.000 to 0.967; κ = 0.540; 95% CI: 0.035 to 1.000, respectively). CONCLUSIONS Upper endoscopy has a high sensitivity, but a low specificity to diagnose megaesophagus. Agreement between the two exams varies depending on the megaesophagus grade. Thus, upper endoscopy can be used in the diagnostic workup of a possible Chagas disease megaesophagus, but all identified cases should undergo esophagography.
publisher Sociedade Brasileira de Medicina Tropical - SBMT
publishDate 2019
url http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822019000100309
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