Gastrointestinal Manifestations of Chagas Disease: A Systematic Review with Meta-Analysis

Nayara Ragi Baldoni University of Itaúna, Itaúna, Brazil;
Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil;

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Lea Campos de Oliveira-da Silva Laboratory of Parasitology (LIM46), Clinical Hospital of São Paulo, Brazil;

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Ana Carolina Oliveira Gonçalves Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil;

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Nayara Dornela Quintino Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil;
Divinópolis Regional Health Superintendence/Minas Gerais State Health Secretariat (SES-MG), Belo Horizonte, Brazil;

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Ariela Mota Ferreira State University of Montes Claros (Unimontes), Montes Claro, Brazil;

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Ana Luiza Bierrenbach Teaching and Research Institute of Sírio-Libanês Hospital, São Paulo, Brazil;
Graduate Program, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil;

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José Luiz Padilha da Silva Department of Statistics, Federal University of Paraná, Curitiba, Brazil;

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Maria Carmo Pereira Nunes Federal University of Minas Gerais, Belo Horizonte, Brazil;

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Antonio Luiz P. Ribeiro Federal University of Minas Gerais, Belo Horizonte, Brazil;

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Claudia Di Lorenzo Oliveira Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil;

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Ester Cerdeira Sabino Institute of Tropical Medicine, Faculty of Medicine, University of São Paulo, Brazil

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Clareci Silva Cardoso Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil;

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ABSTRACT.

The aims of this study were to estimate the prevalence of gastrointestinal manifestations among individuals with positive serology for Chagas disease (ChD) and to describe the clinical gastrointestinal manifestations of the disease. A systematic review with meta-analysis was conducted based on the criteria and recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The PubMed, Scopus, Virtual Health Library, Web of Science, and Embase databases were used to search for evidence. Two reviewers independently selected eligible articles and extracted data. RStudio® software was used for the meta-analysis. For subgroup analysis, the studies were divided according to the origin of the individuals included: 1) individuals from health units were included in the health care service prevalence analysis, and 2) individuals from the general population were included in the population prevalence analysis. A total of 2,570 articles were identified, but after removal of duplicates and application of inclusion criteria, 24 articles were included and 21 were part of the meta-analysis. Most of the studies were conducted in Brazil. Radiological diagnosis was the most frequent method used to identify the gastrointestinal clinical form. The combined effect of meta-analysis studies showed a prevalence of gastrointestinal manifestations in individuals with ChD of 12% (95% CI, 8.0–17.0%). In subgroup analysis, the prevalence for studies involving health care services was 16% (95% CI, 11.0–23.0%), while the prevalence for population-based studies was 9% (95% CI, 5.0–15.0%). Megaesophagus and megacolon were the main forms of ChD presentation in the gastrointestinal form. The prevalence of gastrointestinal manifestations of ChD was 12%. Knowing the prevalence of ChD in its gastrointestinal form is an important step in planning health actions for these patients.

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Author Notes

Financial support: The Sami-Trop cohort study is supported by the NIH (Grant nos. 5U19AI098461 and 1U01AI168383). A. L. P. R. is supported in part by CNPq (Grant nos. 310790/2021-2 and 465518/2014-1) and FAPEMIG (Grant nos. PPM-00428-17 and RED-00081-16).

Authors’ addresses: Nayara Ragi Baldoni, University of Itaúna, Itaúna, Brazil, and Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil, E-mail: nrbaldoni@gamil.com. Lea Campos de Oliveira-da Silva, Laboratory of Parasitology (LIM46), Clinical Hospital of São Paulo, São Paulo, Brazil, E-mail: lea.c.oliveira@gmail.com. Ana Carolina Oliveira Gonçalves, Claudia Di Lorenzo Oliveira, and Clareci Silva Cardoso, Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil, E-mails: aco_goncalves@yahoo.com.br, claudiadlorenzo@gmail.com, and clarecicardoso@yahoo.com.br. Nayara Dornela Quintino, Research Group in Epidemiology and Evaluation of New Technology in Health, UFSJ/CNPq, Medical School, Federal University of de São João del-Rei, Divinópolis, Brazil, and Divinópolis Regional Health Superintendence/Minas Gerais State Health Secretariat (SES-MG), Belo Horizonte, Brazil, E-mail: nayaradornela@yahoo.com.br. Ariela Mota Ferreira, State University of Montes Claros (Unimontes), Montes Claro, Brazil, E-mail: arielamota@hotmail.com. Ana Luiza Bierrenbach, Teaching and Research Institute of Sírio-Libanês Hospital, São Paulo, Brazil, and Graduate Program, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil, E-mail: albierrenbach@yahoo.com.br. José Luiz Padilha da Silva, Department of Statistics, Federal University of Paraná, Curitiba, Brazil, E-mail: jlpadilha@ufpr.br. Maria Carmo Pereira Nunes and Antonia Luiz P. Ribeiro, Federal University of Minas Gerais, Belo Horizonte, Brazil, E-mails: mcarmo@waymail.com.br and tom1963br@yahoo.com.br. Ester Cerdeira Sabino, Institute of Tropical Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil, E-mail: sabinoec@gmail.com.

Address correspondence to Nayara Ragi Baldoni, University of Itauna, Rodovia MG 431 Km 45, s/n, Itaúna, MG, 35680-142, Brazil. E-mail: nrbaldoni@gmail.com
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