The Chronic Gastrointestinal Manifestations of Chagas Disease

array:24 ["pii" => "S1807593222025121" "issn" => "18075932" "doi" => "10.1590/S1807-59322009001200013" "estado" => "S300" "fechaPublicacion" => "2009-12-01" "aid" => "20222512" "copyright" => "CLINICS" "copyrightAnyo" => "2009" "documento" => "article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/" "subdocumento" => "rev" "cita" => "Clinics. 2009;64:1219-24" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S1807593222025133" "issn" => "18075932" "doi" => "10.1590/S1807-59322009001200014" "estado" => "S300" "fechaPublicacion" => "2009-12-01" "aid" => "20222513" "copyright" => "CLINICS" "documento" => "simple-article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/" "subdocumento" => "cor" "cita" => "Clinics. 2009;64:1225-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Successful Treatment of a Resistance Trigeminal Neuralgia Patient By Acupuncture" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1225" "paginaFinal" => "1226" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Hüseyin Sert, Burhanettin Usta, Bünyamin Muslu, Muhammet Gözdemir" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Hüseyin" "apellidos" => "Sert" ] 1 => array:2 [ "nombre" => "Burhanettin" "apellidos" => "Usta" ] 2 => array:2 [ "nombre" => "Bünyamin" "apellidos" => "Muslu" ] 3 => array:2 [ "nombre" => "Muhammet" "apellidos" => "Gözdemir" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222025133?idApp=UINPBA00004N" "url" => "/18075932/0000006400000012/v1_202212060833/S1807593222025133/v1_202212060833/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S180759322202511X" "issn" => "18075932" "doi" => "10.1590/S1807-59322009001200012" "estado" => "S300" "fechaPublicacion" => "2009-12-01" "aid" => "20222511" "copyright" => "CLINICS" "documento" => "article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/" "subdocumento" => "fla" "cita" => "Clinics. 2009;64:1211-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Basic Research" "titulo" => "Ascorbic Acid Protects Against Restraint Stress-Induced Memory Deficits in Wistar Rats" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1211" "paginaFinal" => "1217" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f2-cln64_12p1211" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1227 "Ancho" => 1742 "Tamanyo" => 146354 ] ] "descripcion" => array:1 [ "en" => "A - Progressive learning of rats in different groups during six successive days of water maze training (Fig. 2A). Data represent mean ± SEM (n=6). Normal control/vehicle control vs. stressed, $ P<0.001; stressed vs. stressed + ascorbic acid treated # P<0.001, stressed+ vehicle vs. stressed+ ascorbic acid treated, £ P<0.001; from day 2 to day 6; normal control/vehicle control vs. ascorbic acid treated, on day three,* P<0.05; analysis of variance (ANOVA) with repeated measures followed by Bonferroni (post-hoc). B - Latency to enter the target quadrant during the probe trial. Data represent mean ± SEM (n=6). Normal control vs. stressed, $ P <0.001; stressed vs. stressed + ascorbic acid treated, # P <0.001; stressed+ vehicle vs. stressed+ ascorbic acid treated, £ P<0.001; normal control vs. ascorbic acid treated, ∂ P<0.01; vehicle control vs. ascorbic acid treated,* P<0.01; one-way ANOVA, Tukey (post-hoc). C - Time spent in the target quadrant during the probe trial. Data represent mean ± SEM (n=6). Normal control/vehicle control vs. stressed, $ P<0.001; stressed vs. stressed + ascorbic acid treated # P<0.001, stressed + vehicle control vs. stressed + ascorbic acid treated, £ P<0.001; normal control vs. ascorbic acid treated, ∂ P<0.05; vehicle control vs. ascorbic acid treated,* P<0.01; one-way ANOVA, Tukey (post-hoc). D - Distance traveled in the target quadrant during probe trial test. All data represent mean ± SEM (n=6); normal control vs. stressed, P<0.001; stressed vs. stressed +ascorbic acid treated, P<0.001; stressed+ vehicle vs. stressed+ ascorbic acid treated, £ P<0.001; one-way ANOVA, Tukey test (post-hoc)" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Raju Suresh Kumar, Sareesh Naduvil Narayanan, Satheesha Nayak" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Raju Suresh" "apellidos" => "Kumar" ] 1 => array:2 [ "nombre" => "Sareesh Naduvil" "apellidos" => "Narayanan" ] 2 => array:2 [ "nombre" => "Satheesha" "apellidos" => "Nayak" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S180759322202511X?idApp=UINPBA00004N" "url" => "/18075932/0000006400000012/v1_202212060833/S180759322202511X/v1_202212060833/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "Review" "titulo" => "The Chronic Gastrointestinal Manifestations of Chagas Disease" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1219" "paginaFinal" => "1224" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Nilce Mitiko Matsuda, Steven M. Miller, Paulo R. Barbosa Evora" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Nilce Mitiko" "apellidos" => "Matsuda" "email" => array:1 [ 0 => "nmmatsuda@uol.com.br" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "I" "identificador" => "af1-cln64_12p1219" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "c1-cln64_12p1219" ] ] ] 1 => array:3 [ "nombre" => "Steven M." "apellidos" => "Miller" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "II" "identificador" => "af2-cln64_12p1219" ] ] ] 2 => array:3 [ "nombre" => "Paulo R. Barbosa" "apellidos" => "Evora" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "I" "identificador" => "af1-cln64_12p1219" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Anatomia e Cirurgia, Universidade de São Paulo - Ribeirão Preto/SP, Brazil" "etiqueta" => "I" "identificador" => "af1-cln64_12p1219" ] 1 => array:3 [ "entidad" => "Department of Physiology and Biomedical Engineering, Mayo Clinic - Rochester/Minnesota, USA." "etiqueta" => "II" "identificador" => "af2-cln64_12p1219" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "c1-cln64_12p1219" "etiqueta" => "*" "correspondencia" => "Tel: 55 16 3633.0836" ] ] ] ] "textoCompleto" => "INTRODUCTIONChagas disease, named after the Brazilian physician, bacteriologist and epidemiologist Carlos Chagas who first described it a hundred years ago, is a tropical parasitic disease caused by the flagellate protozoan Trypanosoma cruzi (T. cruzi).<a class="elsevierStyleCrossRef" href="#bib1">1</a>–<a class="elsevierStyleCrossRef" href="#bib3">3</a>The parasite T. cruzi is commonly transmitted to humans and other mammals by a vector insect, the blood-sucking bugs of the subfamily Triatominae.<a class="elsevierStyleCrossRefs" href="#bib1">1,2</a> This disease can also be transmitted by blood transfusion, organ transplantation, from a mother to her fetus and by ingestion of food contaminated with the parasites.<a class="elsevierStyleCrossRefs" href="#bib4">4,5</a>Several years or even decades after the initial infection, approximately 30% of infected people develop medical problems from Chagas disease over the course of their lives.<a class="elsevierStyleCrossRef" href="#bib4">4</a> Chagas disease mainly affects the nervous system, gastrointestinal tract and heart. Most people suffer cardiac damage, including cardiomyopathy, heart rhythm abnormalities and often an apical aneurysm.<a class="elsevierStyleCrossRefs" href="#bib3">3,4</a>Approximately one third of patients can develop dilation of the gastrointestinal tract (megacolon, megaesophagus, megastomach, megaduodenum, megajejunum, megagallbladder, megacholedochus) and gastrointestinal motor disorders, such as achalasia of the cardia, disturbances of gastric emptying, altered intestinal transit and colon and gallbladder motor disorders.<a class="elsevierStyleCrossRefs" href="#bib3">3,4,6</a>–<a class="elsevierStyleCrossRef" href="#bib18">18</a> Chagas disease is known to cause both central nervous system and enteric nervous system injury.<a class="elsevierStyleCrossRefs" href="#bib3">3,4</a> The chronic gastrointestinal manifestations of Chagas disease are mainly a result of enteric nervous system injury caused by T. cruzi infection.<a class="elsevierStyleCrossRef" href="#bib19">19</a>–<a class="elsevierStyleCrossRef" href="#bib25">25</a>The objective of this review is to revise the literature and summarize the main chronic gastrointestinal manifestations described in association with Chagas disease in the year of the hundredth anniversary of the first description of Chagas disease.DISCUSSIONThe chronic gastrointestinal manifestations of Chagas disease are described in the salivary glands, esophagus, lower esophageal sphincter, stomach, small intestine, colon, gallbladder and biliary tree.<a class="elsevierStyleCrossRefs" href="#bib3">3,4,6</a>–<a class="elsevierStyleCrossRefs" href="#bib18">18,26</a> These alterations seem to develop from both excitatory and inhibitory enteric motor innervation impairments.<a class="elsevierStyleCrossRef" href="#bib19">19</a>–<a class="elsevierStyleCrossRef" href="#bib24">24</a> The chronic gastrointestinal manifestations of Chagas disease are described in association with Helicobacter pylori (H. pylori) infection, damage to the interstitial cells of Cajal and the incidence of gastrointestinal cancer.<a class="elsevierStyleCrossRef" href="#bib27">27</a>–<a class="elsevierStyleCrossRef" href="#bib34">34</a>From a total of 4,690 autopsies, 1,708 chagasic chronic post-mortem examinations were performed, and megacolon was the most frequent gastrointestinal manifestation, followed by megaesophagus. Megacolon associated with the megaesophagus was the third most common finding.<a class="elsevierStyleCrossRef" href="#bib35">35</a>The salivary gland manifestations of Chagas diseaseSialorrhea has been described in association with megaesophagus in both patients with Chagas disease and those with idiopathic megaesophagus.<a class="elsevierStyleCrossRef" href="#bib36">36</a> Salivary gland hypertrophy and sialorrhea have been described not only in association with chagasic megaesophagus and idiopathic achalasia, but also in association with other eating disorders, including bulimia and anorexia nervosa.<a class="elsevierStyleCrossRef" href="#bib36">36</a>–<a class="elsevierStyleCrossRef" href="#bib38">38</a> Both salivary gland hypertrophy and sialorrhea seem to be related to the symptoms of vomiting and regurgitation described in these eating disorders and idiopathic and chagasic achalasia.<a class="elsevierStyleCrossRef" href="#bib36">36</a>–<a class="elsevierStyleCrossRef" href="#bib38">38</a>The esophagus and the lower esophageal sphincter manifestations of Chagas diseaseChagasic achalasia and its consequence of chagasic megaesophagus are common findings in Chagas disease, and dysphagia may be the first symptom of digestive disturbances that may lead to malnutrition and severe weight loss.<a class="elsevierStyleCrossRefs" href="#bib8">8,9,35,39,40</a>The nitric oxide (NO) donor drugs were used at the first half of the last century to increase emptying of the megaesophagus and to improve the symptoms of dysphagia in idiopathic achalasia.<a class="elsevierStyleCrossRef" href="#bib41">41</a>–<a class="elsevierStyleCrossRef" href="#bib44">44</a> In chagasic achalasia, there are reports of the use of such drugs for the same purpose in the middle of the last century. However, the presentation of NO-donor drugs and their side effects has limited their use. Only later, with the presentation of such drugs in the form of tablets to be administered orally or sublingually, it was demonstrated that NO-donor drugs decrease lower esophageal sphincter pressure, improve the symptoms of dysphagia and increase megaesophagus clearance in both idiopathic achalasia and chagasic achalasia.<a class="elsevierStyleCrossRef" href="#bib45">45</a>–<a class="elsevierStyleCrossRef" href="#bib53">53</a> Researchers finally demonstrated similarities between the inhibitory non-adrenergic non-cholinergic mediator and the substance released from NO-donor drugs in the late 1980s.<a class="elsevierStyleCrossRefs" href="#bib54">54,55</a>Although chagasic achalasia presents with symptoms and radiological findings similar to those of idiopathic achalasia, some important differences are described.<a class="elsevierStyleCrossRef" href="#bib9">9</a>, <a class="elsevierStyleCrossRef" href="#bib56">56</a>–<a class="elsevierStyleCrossRef" href="#bib58">58</a> It has been demonstrated that, in patients with Chagas disease, pressure in the lower esophageal sphincter is lower than in normal patients, whereas the pressure is higher in patients with idiopathic achalasia.<a class="elsevierStyleCrossRefs" href="#bib7">7,40</a> Higher pressure in the lower esophageal sphincter in idiopathic achalasia relative to that in controls has also been demonstrated by others researchers.<a class="elsevierStyleCrossRefs" href="#bib59">59,60</a> Reduced pressure in the lower esophageal sphincter in chagasic achalasia further demonstrates that both innervations, excitatory and inhibitory, are damaged in contrast to idiopathic achalasia, where the excitatory innervation is preserved, thereby causing the pressure to be higher than in the normal subjects.<a class="elsevierStyleCrossRefs" href="#bib39">39,40,59</a>–<a class="elsevierStyleCrossRef" href="#bib61">61</a> Similarities are also observed in the treatments, including pharmacological, endoscopic and surgical procedures.<a class="elsevierStyleCrossRefs" href="#bib62">62,63</a> In both cases, treatment is palliative, with an objective of decreasing lower esophageal sphincter pressure, improving esophageal emptying and relief of the symptoms of dysphagia.<a class="elsevierStyleCrossRefs" href="#bib62">62,63</a>The stomach manifestations of Chagas diseaseThe megastomach is neither a common nor an important finding of gastrointestinal manifestation in Chagas disease, although alterations in both motility and secretion have been described. Delayed gastric emptying of solid meals has been demonstrated. The explanation provided for this observation is that the excitatory motor enteric neurons are damaged in Chagas disease.<a class="elsevierStyleCrossRefs" href="#bib13">13,64</a> Fast gastric emptying of liquid meals was also demonstrated, and the explanation was related not only to impairment of the excitatory enteric neurons, but also to impairment of inhibitory enteric neurons.<a class="elsevierStyleCrossRef" href="#bib12">12</a>, <a class="elsevierStyleCrossRef" href="#bib15">15</a>Given that inhibitory innervation is responsible for gastric accommodation after a meal, the stomach is not able to relax after a liquid meal once inhibitory enteric innervation is damaged, which results in rapid gastric emptying.<a class="elsevierStyleCrossRefs" href="#bib12">12,15</a>Moreover, electrogastrography performed in patients with Chagas disease showed a higher incidence of gastric dysrhythmias in the chagasic patients than in the normal subjects.<a class="elsevierStyleCrossRef" href="#bib26">26</a> Another alteration demonstrated in patients with Chagas disease is that both basal and stimulated acid gastric secretion were lower than in normal subjects.<a class="elsevierStyleCrossRefs" href="#bib65">65,66</a>The small intestine manifestations of Chagas diseaseAbnormalities of interdigestive motility of the small intestine in Chagas disease have been described.<a class="elsevierStyleCrossRef" href="#bib67">67</a> Manometric studies of gastrointestinal motility showed abnormally slow propagation of the interdigestive migrating motor complex, which was also excessively prolonged.<a class="elsevierStyleCrossRefs" href="#bib66">66,67</a>Although not common, dilation of the small intestine, such as megaduodenum and megajejunum, has also been described.<a class="elsevierStyleCrossRefs" href="#bib14">14,18</a> However, fast transit in the dilated small intestine in Chagas disease has been associated with bacteria overgrowth with chronic diarrhea, malabsorption, steatorrhea and hypocalcemia that improved with oral antibiotic therapy.<a class="elsevierStyleCrossRefs" href="#bib14">14,18</a> Patients with Chagas disease have a combination of very fast gastric emptying and abnormally delayed transit of liquids through the more distal segments of the small bowel.<a class="elsevierStyleCrossRef" href="#bib15">15</a> Also, disorders of absorption in the small intestine were demonstrated in Chagas disease as an abnormal increase in the absorption of carbohydrates.<a class="elsevierStyleCrossRefs" href="#bib2">2,10</a>The colonic manifestations of Chagas diseaseAnother common manifestation of Chagas disease in the gastrointestinal tract is chagasic megacolon. Chronic constipation is the main symptom related to megacolon.<a class="elsevierStyleCrossRefs" href="#bib4">4,6,8,35</a> Although chagasic megacolon presents with symptoms and radiological findings similar to congenital megacolon, differences are also related to damage in both excitatory and inhibitory innervations.<a class="elsevierStyleCrossRefs" href="#bib19">19,20,22,24,25</a> Manometric studies in chagasic patients have demonstrated the basal motility index and wave frequency of the sigmoid colon and rectum to be lower than in normal subjects. In addition, the studies show a lack of relaxation of the internal sphincter of the anus in the chagasic patients.<a class="elsevierStyleCrossRefs" href="#bib6">6,11</a> Others have demonstrated an absence of the rectoanal inhibitory reflex in the chagasic megacolon, similar to that in Hirschsprung’s disease.<a class="elsevierStyleCrossRefs" href="#bib68">68,69</a> Alteration of the rectoanal inhibitory reflex in most of the chagasic patients with megacolon was demonstrated by several researchers and can be justified by the destruction of enteric motor innervations.<a class="elsevierStyleCrossRefs" href="#bib6">6,11,19,20,22,24,25,68,70</a> The choice of surgical treatment appears to have the same indication as a solution for constipation in both chagasic and idiopathic megacolon.<a class="elsevierStyleCrossRefs" href="#bib71">71,72</a>The incidence of diverticula in the sigmoid colon of the non-chagasic group was higher than in both the chagasic group with and without megacolon.<a class="elsevierStyleCrossRef" href="#bib73">73</a> Among the patients with megacolon and diverticular disease, the diverticula were always located in the non-dilated portions of the large bowel, suggesting that unfavorable conditions for the genesis or maintenance of diverticula exist in the dilated colon of the chagasic patients.<a class="elsevierStyleCrossRef" href="#bib73">73</a>The gallbladder and the biliary tree manifestations of Chagas diseaseGallbladder neuron counts in cholelithiasis in patients with Chagas disease have demonstrated a reduction in the number of neurons in the gallbladder wall.<a class="elsevierStyleCrossRef" href="#bib21">21</a> Given that the enteric excitatory motor neurons are damaged in Chagas disease, the prevalence of cholelithiasis, megagallbladder and megacholedochus is higher.<a class="elsevierStyleCrossRefs" href="#bib74">74,75</a> Despite controversial results, a scintigraphic study of gallbladder emptying in Chagas disease showed that the gallbladder of the chagasic patients was much more sensitive to an exogenous cholecystokinetic agent and contracted in a more intense manner, with contraction starting earlier and lasting longer than among the controls, suggesting more severe impairment of the inhibitory enteric innervations.<a class="elsevierStyleCrossRef" href="#bib17">17</a>H. pylori infection and Chagas diseaseIn addition to studies in developing countries, which have a higher incidence of infection by H. pylori, Chagas disease has a higher incidence of peptic changes and a high frequency of peptic disease associated with H. pylori infection.<a class="elsevierStyleCrossRefs" href="#bib29">29,76</a> Another study showed that the prevalence of infection by H. pylori was higher in the chagasic patients than in non-chagasic subjects from both urban and rural areas.<a class="elsevierStyleCrossRef" href="#bib31">31</a> Furthermore, H. pylori was considered a possible factor related to the etiopathogenesis of chronic superficial and atrophic gastritis, since it was frequently observed in patients with the gastrointestinal manifestations of Chagas disease.<a class="elsevierStyleCrossRefs" href="#bib34">34,77</a>The interstitial cells of Cajal and Chagas diseaseInjury to the interstitial cells of Cajal as well as the enteric nervous system have been considered important in gastrointestinal motility control.<a class="elsevierStyleCrossRefs" href="#bib78">78,79</a>Despite the controversy regarding the pathogenic role of defects in the interstitial cells of Cajal in idiopathic constipation and other gastrointestinal motor disorders, changes in the distribution of the interstitial cells of Cajal have been reported in various conditions, such as achalasia, chronic intestinal pseudo-obstruction, infantile hypertrophic pyloric stenosis, Hirschsprung’s disease, inflammatory bowel disease and slow transit constipation.<a class="elsevierStyleCrossRef" href="#bib77">77</a>–<a class="elsevierStyleCrossRef" href="#bib87">87</a> In addition, altered distribution of the interstitial cells of Cajal has been demonstrated in chagasic megaesophagus and in chagasic megacolon.<a class="elsevierStyleCrossRefs" href="#bib27">27,28,30</a>The incidence of gastrointestinal cancer and Chagas diseaseThe association of cancer of the esophagus and megaesophagus has been demonstrated to be both higher and lower in chagasic patients than in normal subjects.<a class="elsevierStyleCrossRefs" href="#bib33">33,88</a> Since a higher prevalence of gastric lesions and infection by H. pylori has been demonstrated, an increased incidence of cancer in the chagasic megaesophagus can be expected.<a class="elsevierStyleCrossRef" href="#bib34">34</a>, <a class="elsevierStyleCrossRef" href="#bib89">89</a>–<a class="elsevierStyleCrossRef" href="#bib91">91</a>A review of 4,690 necropsies and 24,209 surgical specimens showed that the prevalence of malignant tumors of the large bowel was not higher in chagasic megacolon.<a class="elsevierStyleCrossRef" href="#bib32">32</a> Other authors also showed no association between chagasic megacolon and an increased incidence of cancer.<a class="elsevierStyleCrossRef" href="#bib33">33</a> Thus, Chagas disease affects several gastrointestinal regions, but there is no apparent relationship with the increased incidence of cancer and chagasic megacolon, and the main causes of death in elderly chagasic patients are commonly related instead to heart disease.<a class="elsevierStyleCrossRefs" href="#bib32">32,33,92</a>SUMMARYChagas disease is an infectious disease that is described to mainly affect the central nervous system, heart and gastrointestinal tract. The objective of this review is to revise and summarize the main chronic gastrointestinal manifestations described in association with Chagas disease.Chagas disease is related to several chronic gastrointestinal disorders resulting from damage to both excitatory and inhibitory enteric motor innervations, leading to megaesophagus, megacolon, megasmall intestine, megagallbladder, megacholedochus, achalasia of the cardia, changes in gastric receptive relaxation, fast gastric emptying of liquid meals, delayed gastric emptying of solid meals, altered small intestine transit and impairment of colon and gallbladder motility.Chagas disease is also related to hypertrophy of the salivary glands, increased saliva production, decreased acid gastric production and altered small intestinal absorption. In addition, more peptic gastric lesions, a higher incidence of H. pylori infection, a similar incidence of cancer in the colon, a higher incidence of cancer in esophagus and altered distribution of the interstitial cells of Cajal in the megaesophagus and megacolon have also been demonstrated in association with Chagas disease." "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "xpalclavsec1585057" "titulo" => "KEYWORDS:" ] 1 => array:2 [ "identificador" => "cesec10" "titulo" => "INTRODUCTION" ] 2 => array:3 [ "identificador" => "cesec20" "titulo" => "DISCUSSION" "secciones" => array:9 [ 0 => array:2 [ "identificador" => "cesec30" "titulo" => "The salivary gland manifestations of Chagas disease" ] 1 => array:2 [ "identificador" => "cesec40" "titulo" => "The esophagus and the lower esophageal sphincter manifestations of Chagas disease" ] 2 => array:2 [ "identificador" => "cesec50" "titulo" => "The stomach manifestations of Chagas disease" ] 3 => array:2 [ "identificador" => "cesec60" "titulo" => "The small intestine manifestations of Chagas disease" ] 4 => array:2 [ "identificador" => "cesec70" "titulo" => "The colonic manifestations of Chagas disease" ] 5 => array:2 [ "identificador" => "cesec80" "titulo" => "The gallbladder and the biliary tree manifestations of Chagas disease" ] 6 => array:2 [ "identificador" => "cesec90" "titulo" => "H. pylori infection and Chagas disease" ] 7 => array:2 [ "identificador" => "cesec100" "titulo" => "The interstitial cells of Cajal and Chagas disease" ] 8 => array:2 [ "identificador" => "cesec110" "titulo" => "The incidence of gastrointestinal cancer and Chagas disease" ] ] ] 3 => array:2 [ "identificador" => "cesec120" "titulo" => "SUMMARY" ] 4 => array:1 [ "titulo" => "REFERENCES" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-08-27" "fechaAceptado" => "2009-09-18" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "KEYWORDS:" "identificador" => "xpalclavsec1585057" "palabras" => array:4 [ 0 => "Enteric nervous system" 1 => "Gastrointestinal tract" 2 => "Motility disorders" 3 => "Chagas disease, Trypanosoma cruzi" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:1 [ "resumen" => "Chagas disease is an infectious disease caused by the protozoan Trypanosoma cruzi. The disease mainly affects the nervous system, digestive system and heart. The objective of this review is to revise the literature and summarize the main chronic gastrointestinal manifestations of Chagas disease. The chronic gastrointestinal manifestations of Chagas disease are mainly a result of enteric nervous system impairment caused by T. cruzi infection. The anatomical locations most commonly described to be affected by Chagas disease are salivary glands, esophagus, lower esophageal sphincter, stomach, small intestine, colon, gallbladder and biliary tree. Chagas disease has also been studied in association with Helicobacter pylori infection, interstitial cells of Cajal and the incidence of gastrointestinal cancer." ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec10" "bibliografiaReferencia" => array:92 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nova tripanosomiaze humana" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ CRJ Chagas \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Memb Inst Oswaldo Cuz" "fecha" => "1909" "volumen" => "1" "paginaInicial" => "159" "paginaFinal" => "218" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chagas enteropathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ JV Campos \n \t\t\t\t\t\t\t\t """ 1 => """ WL Tafuri \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/gut.14.11.910" "Revista" => array:6 [ "tituloSerie" => "Gut" "fecha" => "1973" "volumen" => "14" "paginaInicial" => "910" "paginaFinal" => "919" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4202602" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chagas’ disease and Chagas’ syndromes: The pathology of American trypanosomiasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ F Koberle \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0065-308x(08)60472-8" "Revista" => array:6 [ "tituloSerie" => "Adv Parasitol" "fecha" => "1968" "volumen" => "6" "paginaInicial" => "63" "paginaFinal" => "116" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4239747" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation and treatment of Chagas disease in the United States: A systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ C Bern \n \t\t\t\t\t\t\t\t """ 1 => """ SP Montgomery \n \t\t\t\t\t\t\t\t """ 2 => """ BL Herwaldt \n \t\t\t\t\t\t\t\t """ 3 => """ A Rassi Jr \n \t\t\t\t\t\t\t\t """ 4 => """ JA Marin-Neto \n \t\t\t\t\t\t\t\t """ 5 => """ RO Dantas \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.298.18.2171" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2007" "volumen" => "298" "paginaInicial" => "2171" "paginaFinal" => "2181" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18000201" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The oral transmission of Chagas disease: An acute form of infection responsible for regional outbreaks" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ PR Benchimol Barbosa \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2005.11.087" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2006" "volumen" => "112" "paginaInicial" => "132" "paginaFinal" => "133" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16600406" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chagas disease: A model of denervation in the study of digestive tract motility" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ UG Meneghelli \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Braz J Med Biol Res" "fecha" => "1985" "volumen" => "18" "paginaInicial" => "255" "paginaFinal" => "264" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3939103" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The lower esophageal sphincter in patients with Chagas disease with peristalsis and aperistalsis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ RO Dantas \n \t\t\t\t\t\t\t\t """ 1 => """ RA Godoy \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arq Gastroenterol" "fecha" => "1983" "volumen" => "20" "paginaInicial" => "13" "paginaFinal" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6414443" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gastrointestinal manifestations of Chagas disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ RB Oliveira \n \t\t\t\t\t\t\t\t """ 1 => """ LE Troncon \n \t\t\t\t\t\t\t\t """ 2 => """ RO Dantas \n \t\t\t\t\t\t\t\t """ 3 => """ UG Menghelli \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1572-0241.1998.270_r.x" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "1998" "volumen" => "93" "paginaInicial" => "884" "paginaFinal" => "889" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9647012" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The spectrum of esophageal motor disorders in Chagas disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ RB Oliveira \n \t\t\t\t\t\t\t\t """ 1 => """ J Rezende Filho \n \t\t\t\t\t\t\t\t """ 2 => """ RO Dantas \n \t\t\t\t\t\t\t\t """ 3 => """ N Iazigi \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "1995" "volumen" => "90" "paginaInicial" => "1119" "paginaFinal" => "1124" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7611209" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chagasic enteropathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ UG Meneghelli \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/s0037-86822004000300012" "Revista" => array:6 [ "tituloSerie" => "Rev Soc Bras Med Trop" "fecha" => "2004" "volumen" => "37" "paginaInicial" => "252" "paginaFinal" => "260" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15330067" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Basal motility of dilated and non-dilated sigmoid colon and rectum in Chagas disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ UG Meneghelli \n \t\t\t\t\t\t\t\t """ 1 => """ RA Godoy \n \t\t\t\t\t\t\t\t """ 2 => """ JF Macedo \n \t\t\t\t\t\t\t\t """ 3 => """ RB Oliveira \n \t\t\t\t\t\t\t\t """ 4 => """ LE Troncon \n \t\t\t\t\t\t\t\t """ 5 => """ RO Dantas \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arq Gastroenterol" "fecha" => "1982" "volumen" => "19" "paginaInicial" => "127" "paginaFinal" => "132" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6821025" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impaired gastric accommodation to distension and rapid gastric emptying in patients with Chagas disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ RB Oliveira \n \t\t\t\t\t\t\t\t """ 1 => """ LE Troncon \n \t\t\t\t\t\t\t\t """ 2 => """ UG Meneghelli \n \t\t\t\t\t\t\t\t """ 3 => """ W Padovan \n \t\t\t\t\t\t\t\t """ 4 => """ RO Dantas \n \t\t\t\t\t\t\t\t """ 5 => """ RA Godoy \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF01345301" "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "1980" "volumen" => "25" "paginaInicial" => "790" "paginaFinal" => "794" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6775917" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudo do esvaziamento gástrico de partículas sólidas digeríveis na gastropatia chagásica crônica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ FP Lopasso \n \t\t\t\t\t\t\t\t """ 1 => """ PE Pinto Jr \n \t\t\t\t\t\t\t\t """ 2 => """ JJ Gama-Rodrigues \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "GED" "fecha" => "1985" "volumen" => "4" "paginaInicial" => "72" "paginaFinal" => "78" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Abnormally rapid gastric emptying of an isosmotic liquid meal in patients with megaduodenum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ LE Troncon \n \t\t\t\t\t\t\t\t """ 1 => """ LR Aprile \n \t\t\t\t\t\t\t\t """ 2 => """ RB Oliveira \n \t\t\t\t\t\t\t\t """ 3 => """ N Iazigi \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1023/a:1026684418333" "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "2000" "volumen" => "45" "paginaInicial" => "2145" "paginaFinal" => "2150" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11215730" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Abnormal progression of a liquid meal through the stomach and small intestine in patients with Chagas disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ LE Troncon \n \t\t\t\t\t\t\t\t """ 1 => """ RB Oliveira \n \t\t\t\t\t\t\t\t """ 2 => """ LM Romanello \n \t\t\t\t\t\t\t\t """ 3 => """ L Rosa-e-Silva \n \t\t\t\t\t\t\t\t """ 4 => """ MC Pinto \n \t\t\t\t\t\t\t\t """ 5 => """ N Iazigi \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF01308613" "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "1993" "volumen" => "38" "paginaInicial" => "1511" "paginaFinal" => "1517" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8344109" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Scintigraphic study of gallbladder emptying in chronic Chagas disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ LE Troncon \n \t\t\t\t\t\t\t\t """ 1 => """ J Rezende Filho \n \t\t\t\t\t\t\t\t """ 2 => """ N Iazigi \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arq Gastroenterol" "fecha" => "1987" "volumen" => "24" "paginaInicial" => "157" "paginaFinal" => "163" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3144963" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gallbladder motor function in chagasic patients with megacolon and/or megaesophagus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ MG Villanova \n \t\t\t\t\t\t\t\t """ 1 => """ UG Meneghelli \n \t\t\t\t\t\t\t\t """ 2 => """ RO Dantas \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000199418" "Revista" => array:6 [ "tituloSerie" => "Digestion" "fecha" => "1987" "volumen" => "36" "paginaInicial" => "189" "paginaFinal" => "194" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3111915" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Small bowel bacterial overgrowth syndrome in chagasic megajejunum: Report of 2 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ LR Aprile \n \t\t\t\t\t\t\t\t """ 1 => """ LE Troncon \n \t\t\t\t\t\t\t\t """ 2 => """ UG Meneghelli \n \t\t\t\t\t\t\t\t """ 3 => """ RB Oliveira \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arq Gastroenterol" "fecha" => "1995" "volumen" => "32" "paginaInicial" => "71" "paginaFinal" => "78" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8540804" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuron count reevaluation in the myenteric plexus of chagasic megacolon after morphometric neuron analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ SJ Adad \n \t\t\t\t\t\t\t\t """ 1 => """ CG Cancado \n \t\t\t\t\t\t\t\t """ 2 => """ RM Etchebehere \n \t\t\t\t\t\t\t\t """ 3 => """ VP Teixeira \n \t\t\t\t\t\t\t\t """ 4 => """ UA Gomes \n \t\t\t\t\t\t\t\t """ 5 => """ E Chapadeiro \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s004280000319" "Revista" => array:6 [ "tituloSerie" => "Virchows Arch" "fecha" => "2001" "volumen" => "438" "paginaInicial" => "254" "paginaFinal" => "258" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11315622" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The enteric nervous system in chagasic and idiopathic megacolon" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ G Iantorno \n \t\t\t\t\t\t\t\t """ 1 => """ G Bassotti \n \t\t\t\t\t\t\t\t """ 2 => """ Z Kogan \n \t\t\t\t\t\t\t\t """ 3 => """ CM Lumi \n \t\t\t\t\t\t\t\t """ 4 => """ AM Cabanne \n \t\t\t\t\t\t\t\t """ 5 => """ S Fisogni \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.pas.0000213371.79300.a8" "Revista" => array:6 [ "tituloSerie" => "Am J Surg Pathol" "fecha" => "2007" "volumen" => "31" "paginaInicial" => "460" "paginaFinal" => "468" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17325489" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib21" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gallbladder neuron count in cholelithiasis patients with and without Chagas disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ E Crema \n \t\t\t\t\t\t\t\t """ 1 => """ LB Ribeiro \n \t\t\t\t\t\t\t\t """ 2 => """ SJ Adad \n \t\t\t\t\t\t\t\t """ 3 => """ RM Ectchebehere \n \t\t\t\t\t\t\t\t """ 4 => """ A Martins Junior \n \t\t\t\t\t\t\t\t """ 5 => """ AA Silva \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/s0037-86822007000100003" "Revista" => array:6 [ "tituloSerie" => "Rev Soc Bras Med Trop" "fecha" => "2007" "volumen" => "40" "paginaInicial" => "15" "paginaFinal" => "17" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17486247" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Megacolon in Chagas disease: A study of inflammatory cells, enteric nerves, and glial cells" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:5 [ 0 => """ AB Silveira \n \t\t\t\t\t\t\t\t """ 1 => """ EM Lemos \n \t\t\t\t\t\t\t\t """ 2 => """ SJ Adad \n \t\t\t\t\t\t\t\t """ 3 => """ R Correa-Oliveira \n \t\t\t\t\t\t\t\t """ 4 => """ JB Furness \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.humpath.2007.01.020" "Revista" => array:6 [ "tituloSerie" => "Hum Pathol" "fecha" => "2007" "volumen" => "38" "paginaInicial" => "1256" "paginaFinal" => "1264" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17490721" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathophysiological significance of neuronal nitric oxide synthase in the gastrointestinal tract" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ T Takahashi \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00535-003-1094-y" "Revista" => array:6 [ "tituloSerie" => "J Gastroenterol" "fecha" => "2003" "volumen" => "38" "paginaInicial" => "421" "paginaFinal" => "430" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12768383" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib24" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of Chagas disease on nitric oxide-containing neurons in severely affected and unaffected intestine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ U Ribeiro Jr \n \t\t\t\t\t\t\t\t """ 1 => """ AV Safatle-Ribeiro \n \t\t\t\t\t\t\t\t """ 2 => """ A Habr-Gama \n \t\t\t\t\t\t\t\t """ 3 => """ JJ Gama-Rodrigues \n \t\t\t\t\t\t\t\t """ 4 => """ J Sohn \n \t\t\t\t\t\t\t\t """ 5 => """ JC Reynolds \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF02237058" "Revista" => array:6 [ "tituloSerie" => "Dis Colon Rectum" "fecha" => "1998" "volumen" => "41" "paginaInicial" => "1411" "paginaFinal" => "1417" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9823808" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib25" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurochemical coding of the enteric nervous system in chagasic patients with megacolon" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ AB Silveira \n \t\t\t\t\t\t\t\t """ 1 => """ D D’Avila Reis \n \t\t\t\t\t\t\t\t """ 2 => """ EC Oliveira \n \t\t\t\t\t\t\t\t """ 3 => """ SG Neto \n \t\t\t\t\t\t\t\t """ 4 => """ AO Luquetti \n \t\t\t\t\t\t\t\t """ 5 => """ D Poole \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10620-006-9680-5" "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "2007" "volumen" => "52" "paginaInicial" => "2877" "paginaFinal" => "2883" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17385032" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib26" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Electrogastrography in patients with Chagas disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ J Rezende Filho \n \t\t\t\t\t\t\t\t """ 1 => """ JM Rezende \n \t\t\t\t\t\t\t\t """ 2 => """ JR Melo \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10620-005-2956-3" "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "2005" "volumen" => "50" "paginaInicial" => "1882" "paginaFinal" => "1888" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16187192" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib27" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A deficiency of interstitial cells of Cajal in chagasic megacolon" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ R Hagger \n \t\t\t\t\t\t\t\t """ 1 => """ C Finlayson \n \t\t\t\t\t\t\t\t """ 2 => """ F Kahn \n \t\t\t\t\t\t\t\t """ 3 => """ R Oliveira \n \t\t\t\t\t\t\t\t """ 4 => """ L Chimelli \n \t\t\t\t\t\t\t\t """ 5 => """ D Kumar \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0165-1838(00)00076-x" "Revista" => array:6 [ "tituloSerie" => "J Auton Nerv Syst" "fecha" => "2000" "volumen" => "80" "paginaInicial" => "108" "paginaFinal" => "111" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10742548" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib28" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interstitial cells of Cajal in patients with chagasic megacolon originating from a region of old endemicity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ RS Geraldino \n \t\t\t\t\t\t\t\t """ 1 => """ AJ Ferreira \n \t\t\t\t\t\t\t\t """ 2 => """ MA Lima \n \t\t\t\t\t\t\t\t """ 3 => """ M Cabrine-Santos \n \t\t\t\t\t\t\t\t """ 4 => """ E Lages-Silva \n \t\t\t\t\t\t\t\t """ 5 => """ LE Ramirez \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pathophys.2005.12.003" "Revista" => array:6 [ "tituloSerie" => "Pathophysiology" "fecha" => "2006" "volumen" => "13" "paginaInicial" => "71" "paginaFinal" => "74" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16500095" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib29" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peptic disease and helicobacter pylori are highly prevalent in patients with the indeterminate form of Chagas disease: Report of 21 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ LC Oliveira \n \t\t\t\t\t\t\t\t """ 1 => """ AG Buso \n \t\t\t\t\t\t\t\t """ 2 => """ L Siqueira Filho \n \t\t\t\t\t\t\t\t """ 3 => """ F Moraes \n \t\t\t\t\t\t\t\t """ 4 => """ HA Oliveira \n \t\t\t\t\t\t\t\t """ 5 => """ RM Oliveira \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/s0036-46651997000400005" "Revista" => array:6 [ "tituloSerie" => "Rev Inst Med Trop São Paulo" "fecha" => "1997" "volumen" => "39" "paginaInicial" => "209" "paginaFinal" => "212" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9640783" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib30" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interstitial cells of Cajal in chagasic megaesophagus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ MA Lima \n \t\t\t\t\t\t\t\t """ 1 => """ M Cabrine-Santos \n \t\t\t\t\t\t\t\t """ 2 => """ MG Tavares \n \t\t\t\t\t\t\t\t """ 3 => """ GP Gerolin \n \t\t\t\t\t\t\t\t """ 4 => """ E Lages-Silva \n \t\t\t\t\t\t\t\t """ 5 => """ LE Ramirez \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.anndiagpath.2007.12.002" "Revista" => array:6 [ "tituloSerie" => "Ann Diagn Pathol" "fecha" => "2008" "volumen" => "12" "paginaInicial" => "271" "paginaFinal" => "274" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18620994" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib31" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Seroprevalence of Helicobacter pylori infection in chronic chagasic patients, and in the rural and urban population from Uberlândia, Minas Gerais, Brazil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ RS Nascimento \n \t\t\t\t\t\t\t\t """ 1 => """ SR Valente \n \t\t\t\t\t\t\t\t """ 2 => """ LC Oliveira \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/s0036-46652002000500003" "Revista" => array:6 [ "tituloSerie" => "Rev Inst Med Trop Sao Paulo" "fecha" => "2002" "volumen" => "44" "paginaInicial" => "251" "paginaFinal" => "254" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12436163" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib32" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Megas and cancer. Cancer of the large intestine in chagasic patients with megacolon" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ AC Meneses \n \t\t\t\t\t\t\t\t """ 1 => """ MA Lopes \n \t\t\t\t\t\t\t\t """ 2 => """ A Rocha \n \t\t\t\t\t\t\t\t """ 3 => """ MC Fatureto \n \t\t\t\t\t\t\t\t """ 4 => """ GP Lopes \n \t\t\t\t\t\t\t\t """ 5 => """ ER Lopes \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arq Gastroenterol" "fecha" => "1989" "volumen" => "26" "paginaInicial" => "13" "paginaFinal" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2513795" …1 ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib33" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A retrospective study of histopathological findings in 894 cases of megacolon: What is the relationship between megacolon and colonic cancer?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/s0036-46652003000200007" "Revista" => array:6 [ "tituloSerie" => "Rev Inst Med Trop São Paulo" "fecha" => "2003" "volumen" => "45" "paginaInicial" => "91" "paginaFinal" => "93" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib34" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic gastritis and helicobacter pylori in digestive form of Chagas disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/s0036-46651993000200002" "Revista" => array:6 [ "tituloSerie" => "Rev Inst Med Trop Sao Paulo" "fecha" => "1993" "volumen" => "35" "paginaInicial" => "117" "paginaFinal" => "121" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib35" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of visceromegalies in necropsies carried out in Triângulo Mineiro from 1954 to 1988" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/s0037-86821989000400008" "Revista" => array:6 [ "tituloSerie" => "Rev Soc Bras Med Trop" "fecha" => "1989" "volumen" => "22" "paginaInicial" => "211" "paginaFinal" => "215" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib36" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sialorrhea. A review of a vexing, often unrecognized sign of oropharyngeal and esophageal disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Gastroenterol" "fecha" => "2005" "volumen" => "39" "paginaInicial" => "89" "paginaFinal" => "97" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib37" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The interrater reliability of physical signs in patients with eating disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/eat.1094" "Revista" => array:6 [ "tituloSerie" => "Int J Eat Disord" "fecha" => "2001" "volumen" => "30" "paginaInicial" => "343" "paginaFinal" => "345" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib38" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parotid gland enlargement in eating disorders: An insensitive sign?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eat Weight Disord" "fecha" => "2008" "volumen" => "13" "paginaInicial" => "79" "paginaFinal" => "83" ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib39" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lower esophageal sphincter pressure in Chagas disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF01536927" "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "1990" "volumen" => "35" "paginaInicial" => "508" "paginaFinal" => "512" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib40" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lower oesophageal sphincter response to pentagastrin in chagasic patients with megaoesophagus and megacolon" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/gut.21.2.85" "Revista" => array:6 [ "tituloSerie" => "Gut" "fecha" => "1980" "volumen" => "21" "paginaInicial" => "85" "paginaFinal" => "90" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib41" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of amyl nitrite as an antispasmodic in the roentgen examination of the gastrointestinal tract" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Roentgenol Radium Ther" "fecha" => "1928" "volumen" => "19" "paginaInicial" => "44" "paginaFinal" => "47" ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib42" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The value of nitrites in cardiospasm (achalasia of the esophagus)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Roentgenol Radium Ther" "fecha" => "1940" "volumen" => "43" "paginaInicial" => "500" "paginaFinal" => "508" ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib43" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Achalasia of the cardia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0140-6736(89)90537-0" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1943" "volumen" => "2" "paginaInicial" => "353" "paginaFinal" => "354" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib44" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Octil nitrite in achalasia of the cardia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1944" "volumen" => "2" "paginaInicial" => "848" "paginaFinal" => "851" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib45" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of nitrates on los pressure in achalasia: A potential therapeutic aid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/gut.22.4.312" "Revista" => array:6 [ "tituloSerie" => "Gut" "fecha" => "1981" "volumen" => "22" "paginaInicial" => "312" "paginaFinal" => "318" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib46" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Isosorbide dinitrate and nifedipine treatment of achalasia: A clinical, manometric and radionuclide evaluation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "1982" "volumen" => "83" "paginaInicial" => "963" "paginaFinal" => "969" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib47" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radionuclide confirmation of the therapeutic value of isosorbide dinitrate in relieving the dysphagia in achalasia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00004836-198202000-00003" "Revista" => array:6 [ "tituloSerie" => "J Clin Gastroenterol" "fecha" => "1982" "volumen" => "4" "paginaInicial" => "17" "paginaFinal" => "22" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib48" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of isosorbide dinitrate and atropine on the lower esophageal sphincter pressure in chagasic patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Physiol Pharmacol Latinoam" "fecha" => "1988" "volumen" => "38" "paginaInicial" => "151" "paginaFinal" => "158" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib49" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of nifedipine on the lower esophageal sphincter pressure in chagasic patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Braz J Med Biol Res" "fecha" => "1986" "volumen" => "19" "paginaInicial" => "205" "paginaFinal" => "209" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 49 => array:3 [ "identificador" => "bib50" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of the effects of sublingual isosorbide dinitrate and cardiomyotomy on esophageal emptying in patients with chagasic megaesophagus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arq Gastroenterol" "fecha" => "1994" "volumen" => "31" "paginaInicial" => "47" "paginaFinal" => "51" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 50 => array:3 [ "identificador" => "bib51" "etiqueta" => "51" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of isosorbide dinitrate for the symptomatic treatment of patients with Chagas disease achalasia. A double-blind, crossover trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Braz J Med Biol Res" "fecha" => "1991" "volumen" => "24" "paginaInicial" => "1093" "paginaFinal" => "1098" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 51 => array:3 [ "identificador" => "bib52" "etiqueta" => "52" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Short report: Comparison of the effects of sublingual nifedipine and isosorbide dinitrate on oesophageal emptying in patients with chagasic achalasia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2036.1992.tb00565.x" "Revista" => array:6 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "1992" "volumen" => "6" "paginaInicial" => "507" "paginaFinal" => "512" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 52 => array:3 [ "identificador" => "bib53" "etiqueta" => "53" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of isosorbide dinitrate on gastroesophageal reflux in healthy volunteers and patients with Chagas disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF02063962" "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "1995" "volumen" => "40" "paginaInicial" => "177" "paginaFinal" => "182" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 53 => array:3 [ "identificador" => "bib54" "etiqueta" => "54" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nitric oxide as an inhibitory non-adrenergic non-cholinergic neurotransmitter" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/345346a0" "Revista" => array:6 [ "tituloSerie" => "Nature" "fecha" => "1990" "volumen" => "345" "paginaInicial" => "346" "paginaFinal" => "347" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 54 => array:3 [ "identificador" => "bib55" "etiqueta" => "55" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nitrergic transmission: Nitric oxide as a mediator of non-adrenergic, non-cholinergic neuro-effector transmission" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1440-1681.1992.tb00433.x" "Revista" => array:6 [ "tituloSerie" => "Clin Exp Pharmacol Physiol" "fecha" => "1992" "volumen" => "19" "paginaInicial" => "147" "paginaFinal" => "169" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 55 => array:3 [ "identificador" => "bib56" "etiqueta" => "56" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic achalasia and chagasic megaesophagus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00004836-198802000-00005" "Revista" => array:6 [ "tituloSerie" => "J Clin Gastroenterol" "fecha" => "1988" "volumen" => "10" "paginaInicial" => "13" "paginaFinal" => "15" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 56 => array:3 [ "identificador" => "bib57" "etiqueta" => "57" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison between idiopathic achalasia and achalasia caused by Chagas disease: A review on the publications about the subject" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/s0004-28032003000200012" "Revista" => array:6 [ "tituloSerie" => "Arq Gastroenterol" "fecha" => "2003" "volumen" => "40" "paginaInicial" => "126" "paginaFinal" => "130" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 57 => array:3 [ "identificador" => "bib58" "etiqueta" => "58" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Are idiopathic and chagasic achalasia two different diseases?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1023/b:ddas.0000020486.71719.62" "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "2004" "volumen" => "49" "paginaInicial" => "353" "paginaFinal" => "360" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 58 => array:3 [ "identificador" => "bib59" "etiqueta" => "59" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manometry and impedance characteristics of achalasia. Facts and myths" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.mcg.0000248013.78020.b4" "Revista" => array:6 [ "tituloSerie" => "J Clin Gastroenterol" "fecha" => "2008" "volumen" => "42" "paginaInicial" => "266" "paginaFinal" => "270" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 59 => array:3 [ "identificador" => "bib60" "etiqueta" => "60" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Achalasia: Physiology and etiopathogenesis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1442-2050.2006.00569.x" "Revista" => array:6 [ "tituloSerie" => "Dis Esophagus" "fecha" => "2006" "volumen" => "19" "paginaInicial" => "213" "paginaFinal" => "223" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 60 => array:3 [ "identificador" => "bib61" "etiqueta" => "61" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patients with achalasia lack nitric oxide synthase in the gastro-oesophageal junction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2362.1993.tb01292.x" "Revista" => array:6 [ "tituloSerie" => "Eur J Clin Invest" "fecha" => "1993" "volumen" => "23" "paginaInicial" => "724" "paginaFinal" => "728" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 61 => array:3 [ "identificador" => "bib62" "etiqueta" => "62" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Achalasia: What is the best treatment?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/1596-3519.55662" "Revista" => array:6 [ "tituloSerie" => "Ann Afr Med" "fecha" => "2008" "volumen" => "7" "paginaInicial" => "141" "paginaFinal" => "148" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 62 => array:3 [ "identificador" => "bib63" "etiqueta" => "63" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopic and surgical treatments for achalasia: A systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SLA.0b013e31818e43ab" "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "2009" "volumen" => "249" "paginaInicial" => "45" "paginaFinal" => "57" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 63 => array:3 [ "identificador" => "bib64" "etiqueta" => "64" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical complications of Chagas’ disease: Megaesophagus, achalasia of the pylorus, and cholelithiasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF01659053" "Revista" => array:6 [ "tituloSerie" => "World J Surg" "fecha" => "1991" "volumen" => "15" "paginaInicial" => "198" "paginaFinal" => "204" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 64 => array:3 [ "identificador" => "bib65" "etiqueta" => "65" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fasting and food-stimulated plasma gastrin levels in chronic Chagas disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000199031" "Revista" => array:6 [ "tituloSerie" => "Digestion" "fecha" => "1984" "volumen" => "29" "paginaInicial" => "171" "paginaFinal" => "176" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 65 => array:3 [ "identificador" => "bib66" "etiqueta" => "66" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Plasma gastrin and gastric acid responses to insulin hypoglycemia in Chagas disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Braz J Med Biol Res" "fecha" => "1985" "volumen" => "18" "paginaInicial" => "273" "paginaFinal" => "278" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 66 => array:3 [ "identificador" => "bib67" "etiqueta" => "67" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Abnormalities of interdigestive motility of the small intestine in patients with Chagas disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF01324944" "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "1983" "volumen" => "28" "paginaInicial" => "294" "paginaFinal" => "299" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 67 => array:3 [ "identificador" => "bib68" "etiqueta" => "68" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of rectoanal inhibitory reflex in chagasic megacolon" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/s0004-28032008000200007" "Revista" => array:6 [ "tituloSerie" => "Arq Gastroenterol" "fecha" => "2008" "volumen" => "45" "paginaInicial" => "128" "paginaFinal" => "131" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 68 => array:3 [ "identificador" => "bib69" "etiqueta" => "69" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness of anorectal manometry using the balloon method to identify the inhibitory recto-anal reflex for diagnosis of Hirschsprung’s disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/s0104-42302005000600013" "Revista" => array:6 [ "tituloSerie" => "Rev Assoc Med Bras" "fecha" => "2005" "volumen" => "51" "paginaInicial" => "313" "paginaFinal" => "317" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 69 => array:3 [ "identificador" => "bib70" "etiqueta" => "70" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Novel concepts in the diagnosis, pathophysiology and management of idiopathic megabowel" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1463-1318.2007.01457.x" "Revista" => array:6 [ "tituloSerie" => "Colorectal Dis" "fecha" => "2008" "volumen" => "10" "paginaInicial" => "531" "paginaFinal" => "538" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 70 => array:3 [ "identificador" => "bib71" "etiqueta" => "71" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical treatment of Chagas megacolon. Critical analysis of outcome in operative methods" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/s0102-86502008000700015" "Revista" => array:6 [ "tituloSerie" => "Acta Cir Bras" "fecha" => "2008" "volumen" => "23" "paginaInicial" => "83" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 71 => array:3 [ "identificador" => "bib72" "etiqueta" => "72" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgery of chagasic megacolon" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF01659052" "Revista" => array:6 [ "tituloSerie" => "World J Surg" "fecha" => "1991" "volumen" => "15" "paginaInicial" => "188" "paginaFinal" => "197" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 72 => array:3 [ "identificador" => "bib73" "etiqueta" => "73" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of diverticular disease of the large bowel in non-chagasic and chagasic individuals with and without megacolon" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arq Gastroenterol" "fecha" => "1986" "volumen" => "23" "paginaInicial" => "3" "paginaFinal" => "8" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 73 => array:3 [ "identificador" => "bib74" "etiqueta" => "74" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cholelithiasis in chronic Chagas disease patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arq Gastroenterol" "fecha" => "1997" "volumen" => "34" "paginaInicial" => "222" "paginaFinal" => "226" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 74 => array:3 [ "identificador" => "bib75" "etiqueta" => "75" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Rocha A, Almeida HO, Teixeira VP, Silva AM. Prevalence of cholelithiasis in necropsies of patients with chronic Chagas’ disease in the mining triangle–correlation with megaesophagus, megacolon and cardiac insufficiency. Arq Gastroenterol. 1085; 22, 3-6" ] ] ] 75 => array:3 [ "identificador" => "bib76" "etiqueta" => "76" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical outcomes of eradication of helicobacter pylori in nonulcer dyspepsia in a population with a high prevalence of infection: Results of a 12-month randomized, double blind, placebo-controlled study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10620-006-3090-6" "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "2006" "volumen" => "51" "paginaInicial" => "89" "paginaFinal" => "98" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 76 => array:3 [ "identificador" => "bib77" "etiqueta" => "77" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and treatment of chronic gastroparesis and chronic intestinal pseudo-obstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0889-8553(03)00028-1" "Revista" => array:6 [ "tituloSerie" => "Gastroenterol Clin North Am" "fecha" => "2003" "volumen" => "32" "paginaInicial" => "619" "paginaFinal" => "658" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 77 => array:3 [ "identificador" => "bib78" "etiqueta" => "78" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interstitial cells of Cajal in the gut–a gastroenterologist’s point of view" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3748/wjg.14.6285" "Revista" => array:6 [ "tituloSerie" => "World J Gastroenterol" "fecha" => "2008" "volumen" => "14" "paginaInicial" => "6285" "paginaFinal" => "6288" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 78 => array:3 [ "identificador" => "bib79" "etiqueta" => "79" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is constipation caused by a loss of colonic interstitial cells of Cajal?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0016-5085(03)00829-1" "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2003" "volumen" => "125" "paginaInicial" => "264" "paginaFinal" => "265" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 79 => array:3 [ "identificador" => "bib80" "etiqueta" => "80" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interstitial cells of Cajal in health and disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2982.2008.01109.x" "Revista" => array:6 [ "tituloSerie" => "Neurogastroenterol Motil" "fecha" => "2008" "volumen" => "20" "paginaInicial" => "54" "paginaFinal" => "63" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 80 => array:3 [ "identificador" => "bib81" "etiqueta" => "81" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Decreased interstitial cells of Cajal in the sigmoid colon of patients with slow transit constipation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00384-003-0577-x" "Revista" => array:6 [ "tituloSerie" => "Int J Colorectal Dis" "fecha" => "2004" "volumen" => "19" "paginaInicial" => "467" "paginaFinal" => "473" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 81 => array:3 [ "identificador" => "bib82" "etiqueta" => "82" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pan-colonic decrease in interstitial cells of Cajal in patients with slow transit constipation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/gut.51.4.496" "Revista" => array:6 [ "tituloSerie" => "Gut" "fecha" => "2002" "volumen" => "51" "paginaInicial" => "496" "paginaFinal" => "501" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 82 => array:3 [ "identificador" => "bib83" "etiqueta" => "83" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alterations in the density of interstitial cells of Cajal in achalasia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10620-007-0053-5" "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "2008" "volumen" => "53" "paginaInicial" => "1488" "paginaFinal" => "1492" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 83 => array:3 [ "identificador" => "bib84" "etiqueta" => "84" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reduction of interstitial cells of Cajal (ICC) associated with neuronal nitric oxide synthase (n-NOS) in patients with achalasia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1572-0241.2007.01667.x" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2008" "volumen" => "103" "paginaInicial" => "856" "paginaFinal" => "864" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 84 => array:3 [ "identificador" => "bib85" "etiqueta" => "85" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interstitial cells of Cajal reduce in number in recto-sigmoid Hirschsprung’s disease and total colonic aganglionosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.neulet.2009.01.015" "Revista" => array:6 [ "tituloSerie" => "Neurosci Lett" "fecha" => "2009" "volumen" => "451" "paginaInicial" => "208" "paginaFinal" => "211" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 85 => array:3 [ "identificador" => "bib86" "etiqueta" => "86" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Distribution of interstitial cells of Cajal and nitrergic neurons in normal and diabetic human appendix" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2982.2007.01040.x" "Revista" => array:6 [ "tituloSerie" => "Neurogastroenterol Motil" "fecha" => "2008" "volumen" => "20" "paginaInicial" => "349" "paginaFinal" => "357" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 86 => array:3 [ "identificador" => "bib87" "etiqueta" => "87" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic intestinal pseudoobstruction associated with altered interstitial cells of Cajal networks" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00005176-200304000-00016" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Gastroenterol Nutr" "fecha" => "2003" "volumen" => "36" "paginaInicial" => "492" "paginaFinal" => "497" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 87 => array:3 [ "identificador" => "bib88" "etiqueta" => "88" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopy in megaesophagus. Prospective study of 600 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arq Gastroenterol" "fecha" => "1985" "volumen" => "22" "paginaInicial" => "53" "paginaFinal" => "62" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 88 => array:3 [ "identificador" => "bib89" "etiqueta" => "89" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association of Helicobacter pylori infection with gastric carcinoma: A meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1572-0241.1999.01360.x" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "1999" "volumen" => "94" "paginaInicial" => "2373" "paginaFinal" => "2379" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 89 => array:3 [ "identificador" => "bib90" "etiqueta" => "90" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increased prevalence of precancerous changes in relatives of gastric cancer patients: Critical role of H. pylori" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0016-5085(00)70410-0" "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2000" "volumen" => "118" "paginaInicial" => "22" "paginaFinal" => "30" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 90 => array:3 [ "identificador" => "bib91" "etiqueta" => "91" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of Helicobacter pylori and prevention of gastric cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1443-9573.2007.00315.x" "Revista" => array:6 [ "tituloSerie" => "J Dig Dis" "fecha" => "2008" "volumen" => "9" "paginaInicial" => "8" "paginaFinal" => "13" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 91 => array:3 [ "identificador" => "bib92" "etiqueta" => "92" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Basic causes of death in elderly patients with Chagas disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arq Bras Cardiol" "fecha" => "1989" "volumen" => "52" "paginaInicial" => "75" "paginaFinal" => "78" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/18075932/0000006400000012/v1_202212060833/S1807593222025121/v1_202212060833/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/18075932/0000006400000012/v1_202212060833/S1807593222025121/v1_202212060833/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222025121?idApp=UINPBA00004N"]

Statistics

Review

Nilce Mitiko MatsudaI,

Corresponding author

nmmatsuda@uol.com.br

Tel: 55 16 3633.0836

, Steven M. MillerII, Paulo R. Barbosa EvoraI

I Departamento de Anatomia e Cirurgia, Universidade de São Paulo - Ribeirão Preto/SP, Brazil

II Department of Physiology and Biomedical Engineering, Mayo Clinic - Rochester/Minnesota, USA.

Read

864

Times
was read the article

299

Total PDF

565

Total HTML

Share statistics

 array:24 [
  "pii" => "S1807593222025121"
  "issn" => "18075932"
  "doi" => "10.1590/S1807-59322009001200013"
  "estado" => "S300"
  "fechaPublicacion" => "2009-12-01"
  "aid" => "20222512"
  "copyright" => "CLINICS"
  "copyrightAnyo" => "2009"
  "documento" => "article"
  "crossmark" => 0
  "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/"
  "subdocumento" => "rev"
  "cita" => "Clinics. 2009;64:1219-24"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1807593222025133"
    "issn" => "18075932"
    "doi" => "10.1590/S1807-59322009001200014"
    "estado" => "S300"
    "fechaPublicacion" => "2009-12-01"
    "aid" => "20222513"
    "copyright" => "CLINICS"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/"
    "subdocumento" => "cor"
    "cita" => "Clinics. 2009;64:1225-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "Successful Treatment of a Resistance Trigeminal Neuralgia Patient By Acupuncture"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "1225"
          "paginaFinal" => "1226"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "H&#252;seyin Sert, Burhanettin Usta, B&#252;nyamin Muslu, Muhammet G&#246;zdemir"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "H&#252;seyin"
              "apellidos" => "Sert"
            ]
            1 => array:2 [
              "nombre" => "Burhanettin"
              "apellidos" => "Usta"
            ]
            2 => array:2 [
              "nombre" => "B&#252;nyamin"
              "apellidos" => "Muslu"
            ]
            3 => array:2 [
              "nombre" => "Muhammet"
              "apellidos" => "G&#246;zdemir"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222025133?idApp=UINPBA00004N"
    "url" => "/18075932/0000006400000012/v1_202212060833/S1807593222025133/v1_202212060833/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S180759322202511X"
    "issn" => "18075932"
    "doi" => "10.1590/S1807-59322009001200012"
    "estado" => "S300"
    "fechaPublicacion" => "2009-12-01"
    "aid" => "20222511"
    "copyright" => "CLINICS"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/"
    "subdocumento" => "fla"
    "cita" => "Clinics. 2009;64:1211-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Basic Research</span>"
      "titulo" => "Ascorbic Acid Protects Against Restraint Stress-Induced Memory Deficits in Wistar Rats"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "1211"
          "paginaFinal" => "1217"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "f2-cln64_12p1211"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1227
              "Ancho" => 1742
              "Tamanyo" => 146354
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">A -</span> Progressive learning of rats in different groups during six successive days of water maze training &#40;Fig&#46; 2A&#41;&#46; Data represent mean &#177; SEM &#40;n&#61;6&#41;&#46; Normal control&#47;vehicle control vs&#46; stressed&#44; &#36; P&#60;0&#46;001&#59; stressed vs&#46; stressed &#43; ascorbic acid treated &#35; P&#60;0&#46;001&#44; stressed&#43; vehicle vs&#46; stressed&#43; ascorbic acid treated&#44; &#163; P&#60;0&#46;001&#59; from day 2 to day 6&#59; normal control&#47;vehicle control vs&#46; ascorbic acid treated&#44; on day three&#44;&#42; P&#60;0&#46;05&#59; analysis of variance &#40;ANOVA&#41; with repeated measures followed by Bonferroni &#40;post-hoc&#41;&#46; <span class="elsevierStyleBold">B -</span> Latency to enter the target quadrant during the probe trial&#46; Data represent mean &#177; SEM &#40;n&#61;6&#41;&#46; Normal control vs&#46; stressed&#44; &#36; P &#60;0&#46;001&#59; stressed vs&#46; stressed &#43; ascorbic acid treated&#44; &#35; P &#60;0&#46;001&#59; stressed&#43; vehicle vs&#46; stressed&#43; ascorbic acid treated&#44; &#163; P&#60;0&#46;001&#59; normal control vs&#46; ascorbic acid treated&#44; &#8706; P&#60;0&#46;01&#59; vehicle control vs&#46; ascorbic acid treated&#44;&#42; P&#60;0&#46;01&#59; one-way ANOVA&#44; Tukey &#40;post-hoc&#41;&#46; <span class="elsevierStyleBold">C -</span> Time spent in the target quadrant during the probe trial&#46; Data represent mean &#177; SEM &#40;n&#61;6&#41;&#46; Normal control&#47;vehicle control vs&#46; stressed&#44; &#36; P&#60;0&#46;001&#59; stressed vs&#46; stressed &#43; ascorbic acid treated &#35; P&#60;0&#46;001&#44; stressed &#43; vehicle control vs&#46; stressed &#43; ascorbic acid treated&#44; &#163; P&#60;0&#46;001&#59; normal control vs&#46; ascorbic acid treated&#44; &#8706; P&#60;0&#46;05&#59; vehicle control vs&#46; ascorbic acid treated&#44;&#42; P&#60;0&#46;01&#59; one-way ANOVA&#44; Tukey &#40;post-hoc&#41;&#46; <span class="elsevierStyleBold">D -</span> Distance traveled in the target quadrant during probe trial test&#46; All data represent mean &#177; SEM &#40;n&#61;6&#41;&#59; normal control vs&#46; stressed&#44; P&#60;0&#46;001&#59; stressed vs&#46; stressed &#43;ascorbic acid treated&#44; P&#60;0&#46;001&#59; stressed&#43; vehicle vs&#46; stressed&#43; ascorbic acid treated&#44; &#163; P&#60;0&#46;001&#59; one-way ANOVA&#44; Tukey test &#40;post-hoc&#41;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Raju Suresh Kumar, Sareesh Naduvil Narayanan, Satheesha Nayak"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Raju Suresh"
              "apellidos" => "Kumar"
            ]
            1 => array:2 [
              "nombre" => "Sareesh Naduvil"
              "apellidos" => "Narayanan"
            ]
            2 => array:2 [
              "nombre" => "Satheesha"
              "apellidos" => "Nayak"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S180759322202511X?idApp=UINPBA00004N"
    "url" => "/18075932/0000006400000012/v1_202212060833/S180759322202511X/v1_202212060833/en/main.assets"
  ]
  "en" => array:16 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
    "titulo" => "The Chronic Gastrointestinal Manifestations of Chagas Disease"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "1219"
        "paginaFinal" => "1224"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Nilce Mitiko Matsuda, Steven M&#46; Miller, Paulo R&#46; Barbosa Evora"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Nilce Mitiko"
            "apellidos" => "Matsuda"
            "email" => array:1 [
              0 => "nmmatsuda@uol.com.br"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">I</span>"
                "identificador" => "af1-cln64_12p1219"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "c1-cln64_12p1219"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Steven M&#46;"
            "apellidos" => "Miller"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">II</span>"
                "identificador" => "af2-cln64_12p1219"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Paulo R&#46; Barbosa"
            "apellidos" => "Evora"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">I</span>"
                "identificador" => "af1-cln64_12p1219"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Departamento de Anatomia e Cirurgia&#44; Universidade de S&#227;o Paulo - Ribeir&#227;o Preto&#47;SP&#44; Brazil"
            "etiqueta" => "I"
            "identificador" => "af1-cln64_12p1219"
          ]
          1 => array:3 [
            "entidad" => "Department of Physiology and Biomedical Engineering&#44; Mayo Clinic - Rochester&#47;Minnesota&#44; USA&#46;"
            "etiqueta" => "II"
            "identificador" => "af2-cln64_12p1219"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "c1-cln64_12p1219"
            "etiqueta" => "&#42;"
            "correspondencia" => "Tel&#58; 55 16 3633&#46;0836"
          ]
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">Chagas disease&#44; named after the Brazilian physician&#44; bacteriologist and epidemiologist Carlos Chagas who first described it a hundred years ago&#44; is a tropical parasitic disease caused by the flagellate protozoan <span class="elsevierStyleItalic">Trypanosoma cruzi</span> &#40;<span class="elsevierStyleItalic">T&#46; cruzi</span>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib1">1</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib3">3</a></p><p id="para20" class="elsevierStylePara elsevierViewall">The parasite <span class="elsevierStyleItalic">T&#46; cruzi</span> is commonly transmitted to humans and other mammals by a vector insect&#44; the blood-sucking bugs of the subfamily Triatominae&#46;<a class="elsevierStyleCrossRefs" href="#bib1">1&#44;2</a> This disease can also be transmitted by blood transfusion&#44; organ transplantation&#44; from a mother to her fetus and by ingestion of food contaminated with the parasites&#46;<a class="elsevierStyleCrossRefs" href="#bib4">4&#44;5</a></p><p id="para30" class="elsevierStylePara elsevierViewall">Several years or even decades after the initial infection&#44; approximately 30&#37; of infected people develop medical problems from Chagas disease over the course of their lives&#46;<a class="elsevierStyleCrossRef" href="#bib4">4</a> Chagas disease mainly affects the nervous system&#44; gastrointestinal tract and heart&#46; Most people suffer cardiac damage&#44; including cardiomyopathy&#44; heart rhythm abnormalities and often an apical aneurysm&#46;<a class="elsevierStyleCrossRefs" href="#bib3">3&#44;4</a></p><p id="para40" class="elsevierStylePara elsevierViewall">Approximately one third of patients can develop dilation of the gastrointestinal tract &#40;megacolon&#44; megaesophagus&#44; megastomach&#44; megaduodenum&#44; megajejunum&#44; megagallbladder&#44; megacholedochus&#41; and gastrointestinal motor disorders&#44; such as achalasia of the cardia&#44; disturbances of gastric emptying&#44; altered intestinal transit and colon and gallbladder motor disorders&#46;<a class="elsevierStyleCrossRefs" href="#bib3">3&#44;4&#44;6</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib18">18</a> Chagas disease is known to cause both central nervous system and enteric nervous system injury&#46;<a class="elsevierStyleCrossRefs" href="#bib3">3&#44;4</a> The chronic gastrointestinal manifestations of Chagas disease are mainly a result of enteric nervous system injury caused by <span class="elsevierStyleItalic">T&#46; cruzi</span> infection&#46;<a class="elsevierStyleCrossRef" href="#bib19">19</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib25">25</a></p><p id="para50" class="elsevierStylePara elsevierViewall">The objective of this review is to revise the literature and summarize the main chronic gastrointestinal manifestations described in association with Chagas disease in the year of the hundredth anniversary of the first description of Chagas disease&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">DISCUSSION</span><p id="para60" class="elsevierStylePara elsevierViewall">The chronic gastrointestinal manifestations of Chagas disease are described in the salivary glands&#44; esophagus&#44; lower esophageal sphincter&#44; stomach&#44; small intestine&#44; colon&#44; gallbladder and biliary tree&#46;<a class="elsevierStyleCrossRefs" href="#bib3">3&#44;4&#44;6</a>&#8211;<a class="elsevierStyleCrossRefs" href="#bib18">18&#44;26</a> These alterations seem to develop from both excitatory and inhibitory enteric motor innervation impairments&#46;<a class="elsevierStyleCrossRef" href="#bib19">19</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib24">24</a> The chronic gastrointestinal manifestations of Chagas disease are described in association with <span class="elsevierStyleItalic">Helicobacter pylori</span> &#40;<span class="elsevierStyleItalic">H&#46; pylori</span>&#41; infection&#44; damage to the interstitial cells of Cajal and the incidence of gastrointestinal cancer&#46;<a class="elsevierStyleCrossRef" href="#bib27">27</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib34">34</a></p><p id="para70" class="elsevierStylePara elsevierViewall">From a total of 4&#44;690 autopsies&#44; 1&#44;708 chagasic chronic post-mortem examinations were performed&#44; and megacolon was the most frequent gastrointestinal manifestation&#44; followed by megaesophagus&#46; Megacolon associated with the megaesophagus was the third most common finding&#46;<a class="elsevierStyleCrossRef" href="#bib35">35</a></p><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">The salivary gland manifestations of Chagas disease</span><p id="para80" class="elsevierStylePara elsevierViewall">Sialorrhea has been described in association with megaesophagus in both patients with Chagas disease and those with idiopathic megaesophagus&#46;<a class="elsevierStyleCrossRef" href="#bib36">36</a> Salivary gland hypertrophy and sialorrhea have been described not only in association with chagasic megaesophagus and idiopathic achalasia&#44; but also in association with other eating disorders&#44; including bulimia and anorexia nervosa&#46;<a class="elsevierStyleCrossRef" href="#bib36">36</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib38">38</a> Both salivary gland hypertrophy and sialorrhea seem to be related to the symptoms of vomiting and regurgitation described in these eating disorders and idiopathic and chagasic achalasia&#46;<a class="elsevierStyleCrossRef" href="#bib36">36</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib38">38</a></p></span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle50">The esophagus and the lower esophageal sphincter manifestations of Chagas disease</span><p id="para90" class="elsevierStylePara elsevierViewall">Chagasic achalasia and its consequence of chagasic megaesophagus are common findings in Chagas disease&#44; and dysphagia may be the first symptom of digestive disturbances that may lead to malnutrition and severe weight loss&#46;<a class="elsevierStyleCrossRefs" href="#bib8">8&#44;9&#44;35&#44;39&#44;40</a></p><p id="para100" class="elsevierStylePara elsevierViewall">The nitric oxide &#40;NO&#41; donor drugs were used at the first half of the last century to increase emptying of the megaesophagus and to improve the symptoms of dysphagia in idiopathic achalasia&#46;<a class="elsevierStyleCrossRef" href="#bib41">41</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib44">44</a> In chagasic achalasia&#44; there are reports of the use of such drugs for the same purpose in the middle of the last century&#46; However&#44; the presentation of NO-donor drugs and their side effects has limited their use&#46; Only later&#44; with the presentation of such drugs in the form of tablets to be administered orally or sublingually&#44; it was demonstrated that NO-donor drugs decrease lower esophageal sphincter pressure&#44; improve the symptoms of dysphagia and increase megaesophagus clearance in both idiopathic achalasia and chagasic achalasia&#46;<a class="elsevierStyleCrossRef" href="#bib45">45</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib53">53</a> Researchers finally demonstrated similarities between the inhibitory non-adrenergic non-cholinergic mediator and the substance released from NO-donor drugs in the late 1980s&#46;<a class="elsevierStyleCrossRefs" href="#bib54">54&#44;55</a></p><p id="para110" class="elsevierStylePara elsevierViewall">Although chagasic achalasia presents with symptoms and radiological findings similar to those of idiopathic achalasia&#44; some important differences are described&#46;<a class="elsevierStyleCrossRef" href="#bib9">9</a>&#44; <a class="elsevierStyleCrossRef" href="#bib56">56</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib58">58</a> It has been demonstrated that&#44; in patients with Chagas disease&#44; pressure in the lower esophageal sphincter is lower than in normal patients&#44; whereas the pressure is higher in patients with idiopathic achalasia&#46;<a class="elsevierStyleCrossRefs" href="#bib7">7&#44;40</a> Higher pressure in the lower esophageal sphincter in idiopathic achalasia relative to that in controls has also been demonstrated by others researchers&#46;<a class="elsevierStyleCrossRefs" href="#bib59">59&#44;60</a> Reduced pressure in the lower esophageal sphincter in chagasic achalasia further demonstrates that both innervations&#44; excitatory and inhibitory&#44; are damaged in contrast to idiopathic achalasia&#44; where the excitatory innervation is preserved&#44; thereby causing the pressure to be higher than in the normal subjects&#46;<a class="elsevierStyleCrossRefs" href="#bib39">39&#44;40&#44;59</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib61">61</a> Similarities are also observed in the treatments&#44; including pharmacological&#44; endoscopic and surgical procedures&#46;<a class="elsevierStyleCrossRefs" href="#bib62">62&#44;63</a> In both cases&#44; treatment is palliative&#44; with an objective of decreasing lower esophageal sphincter pressure&#44; improving esophageal emptying and relief of the symptoms of dysphagia&#46;<a class="elsevierStyleCrossRefs" href="#bib62">62&#44;63</a></p></span><span id="cesec50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle60">The stomach manifestations of Chagas disease</span><p id="para120" class="elsevierStylePara elsevierViewall">The megastomach is neither a common nor an important finding of gastrointestinal manifestation in Chagas disease&#44; although alterations in both motility and secretion have been described&#46; Delayed gastric emptying of solid meals has been demonstrated&#46; The explanation provided for this observation is that the excitatory motor enteric neurons are damaged in Chagas disease&#46;<a class="elsevierStyleCrossRefs" href="#bib13">13&#44;64</a> Fast gastric emptying of liquid meals was also demonstrated&#44; and the explanation was related not only to impairment of the excitatory enteric neurons&#44; but also to impairment of inhibitory enteric neurons&#46;<a class="elsevierStyleCrossRef" href="#bib12">12</a>&#44; <a class="elsevierStyleCrossRef" href="#bib15">15</a></p><p id="para130" class="elsevierStylePara elsevierViewall">Given that inhibitory innervation is responsible for gastric accommodation after a meal&#44; the stomach is not able to relax after a liquid meal once inhibitory enteric innervation is damaged&#44; which results in rapid gastric emptying&#46;<a class="elsevierStyleCrossRefs" href="#bib12">12&#44;15</a></p><p id="para140" class="elsevierStylePara elsevierViewall">Moreover&#44; electrogastrography performed in patients with Chagas disease showed a higher incidence of gastric dysrhythmias in the chagasic patients than in the normal subjects&#46;<a class="elsevierStyleCrossRef" href="#bib26">26</a> Another alteration demonstrated in patients with Chagas disease is that both basal and stimulated acid gastric secretion were lower than in normal subjects&#46;<a class="elsevierStyleCrossRefs" href="#bib65">65&#44;66</a></p></span><span id="cesec60" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">The small intestine manifestations of Chagas disease</span><p id="para150" class="elsevierStylePara elsevierViewall">Abnormalities of interdigestive motility of the small intestine in Chagas disease have been described&#46;<a class="elsevierStyleCrossRef" href="#bib67">67</a> Manometric studies of gastrointestinal motility showed abnormally slow propagation of the interdigestive migrating motor complex&#44; which was also excessively prolonged&#46;<a class="elsevierStyleCrossRefs" href="#bib66">66&#44;67</a></p><p id="para160" class="elsevierStylePara elsevierViewall">Although not common&#44; dilation of the small intestine&#44; such as megaduodenum and megajejunum&#44; has also been described&#46;<a class="elsevierStyleCrossRefs" href="#bib14">14&#44;18</a> However&#44; fast transit in the dilated small intestine in Chagas disease has been associated with bacteria overgrowth with chronic diarrhea&#44; malabsorption&#44; steatorrhea and hypocalcemia that improved with oral antibiotic therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib14">14&#44;18</a> Patients with Chagas disease have a combination of very fast gastric emptying and abnormally delayed transit of liquids through the more distal segments of the small bowel&#46;<a class="elsevierStyleCrossRef" href="#bib15">15</a> Also&#44; disorders of absorption in the small intestine were demonstrated in Chagas disease as an abnormal increase in the absorption of carbohydrates&#46;<a class="elsevierStyleCrossRefs" href="#bib2">2&#44;10</a></p></span><span id="cesec70" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle80">The colonic manifestations of Chagas disease</span><p id="para170" class="elsevierStylePara elsevierViewall">Another common manifestation of Chagas disease in the gastrointestinal tract is chagasic megacolon&#46; Chronic constipation is the main symptom related to megacolon&#46;<a class="elsevierStyleCrossRefs" href="#bib4">4&#44;6&#44;8&#44;35</a> Although chagasic megacolon presents with symptoms and radiological findings similar to congenital megacolon&#44; differences are also related to damage in both excitatory and inhibitory innervations&#46;<a class="elsevierStyleCrossRefs" href="#bib19">19&#44;20&#44;22&#44;24&#44;25</a> Manometric studies in chagasic patients have demonstrated the basal motility index and wave frequency of the sigmoid colon and rectum to be lower than in normal subjects&#46; In addition&#44; the studies show a lack of relaxation of the internal sphincter of the anus in the chagasic patients&#46;<a class="elsevierStyleCrossRefs" href="#bib6">6&#44;11</a> Others have demonstrated an absence of the rectoanal inhibitory reflex in the chagasic megacolon&#44; similar to that in Hirschsprung&#8217;s disease&#46;<a class="elsevierStyleCrossRefs" href="#bib68">68&#44;69</a> Alteration of the rectoanal inhibitory reflex in most of the chagasic patients with megacolon was demonstrated by several researchers and can be justified by the destruction of enteric motor innervations&#46;<a class="elsevierStyleCrossRefs" href="#bib6">6&#44;11&#44;19&#44;20&#44;22&#44;24&#44;25&#44;68&#44;70</a> The choice of surgical treatment appears to have the same indication as a solution for constipation in both chagasic and idiopathic megacolon&#46;<a class="elsevierStyleCrossRefs" href="#bib71">71&#44;72</a></p><p id="para180" class="elsevierStylePara elsevierViewall">The incidence of diverticula in the sigmoid colon of the non-chagasic group was higher than in both the chagasic group with and without megacolon&#46;<a class="elsevierStyleCrossRef" href="#bib73">73</a> Among the patients with megacolon and diverticular disease&#44; the diverticula were always located in the non-dilated portions of the large bowel&#44; suggesting that unfavorable conditions for the genesis or maintenance of diverticula exist in the dilated colon of the chagasic patients&#46;<a class="elsevierStyleCrossRef" href="#bib73">73</a></p></span><span id="cesec80" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle90">The gallbladder and the biliary tree manifestations of Chagas disease</span><p id="para190" class="elsevierStylePara elsevierViewall">Gallbladder neuron counts in cholelithiasis in patients with Chagas disease have demonstrated a reduction in the number of neurons in the gallbladder wall&#46;<a class="elsevierStyleCrossRef" href="#bib21">21</a> Given that the enteric excitatory motor neurons are damaged in Chagas disease&#44; the prevalence of cholelithiasis&#44; megagallbladder and megacholedochus is higher&#46;<a class="elsevierStyleCrossRefs" href="#bib74">74&#44;75</a> Despite controversial results&#44; a scintigraphic study of gallbladder emptying in Chagas disease showed that the gallbladder of the chagasic patients was much more sensitive to an exogenous cholecystokinetic agent and contracted in a more intense manner&#44; with contraction starting earlier and lasting longer than among the controls&#44; suggesting more severe impairment of the inhibitory enteric innervations&#46;<a class="elsevierStyleCrossRef" href="#bib17">17</a></p></span><span id="cesec90" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle100">H&#46; pylori infection and Chagas disease</span><p id="para200" class="elsevierStylePara elsevierViewall">In addition to studies in developing countries&#44; which have a higher incidence of infection by <span class="elsevierStyleItalic">H&#46; pylori</span>&#44; Chagas disease has a higher incidence of peptic changes and a high frequency of peptic disease associated with <span class="elsevierStyleItalic">H&#46; pylori</span> infection&#46;<a class="elsevierStyleCrossRefs" href="#bib29">29&#44;76</a> Another study showed that the prevalence of infection by <span class="elsevierStyleItalic">H&#46; pylori</span> was higher in the chagasic patients than in non-chagasic subjects from both urban and rural areas&#46;<a class="elsevierStyleCrossRef" href="#bib31">31</a> Furthermore&#44; <span class="elsevierStyleItalic">H&#46; pylori</span> was considered a possible factor related to the etiopathogenesis of chronic superficial and atrophic gastritis&#44; since it was frequently observed in patients with the gastrointestinal manifestations of Chagas disease&#46;<a class="elsevierStyleCrossRefs" href="#bib34">34&#44;77</a></p></span><span id="cesec100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle110">The interstitial cells of Cajal and Chagas disease</span><p id="para210" class="elsevierStylePara elsevierViewall">Injury to the interstitial cells of Cajal as well as the enteric nervous system have been considered important in gastrointestinal motility control&#46;<a class="elsevierStyleCrossRefs" href="#bib78">78&#44;79</a></p><p id="para220" class="elsevierStylePara elsevierViewall">Despite the controversy regarding the pathogenic role of defects in the interstitial cells of Cajal in idiopathic constipation and other gastrointestinal motor disorders&#44; changes in the distribution of the interstitial cells of Cajal have been reported in various conditions&#44; such as achalasia&#44; chronic intestinal pseudo-obstruction&#44; infantile hypertrophic pyloric stenosis&#44; Hirschsprung&#8217;s disease&#44; inflammatory bowel disease and slow transit constipation&#46;<a class="elsevierStyleCrossRef" href="#bib77">77</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib87">87</a> In addition&#44; altered distribution of the interstitial cells of Cajal has been demonstrated in chagasic megaesophagus and in chagasic megacolon&#46;<a class="elsevierStyleCrossRefs" href="#bib27">27&#44;28&#44;30</a></p></span><span id="cesec110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle120">The incidence of gastrointestinal cancer and Chagas disease</span><p id="para230" class="elsevierStylePara elsevierViewall">The association of cancer of the esophagus and megaesophagus has been demonstrated to be both higher and lower in chagasic patients than in normal subjects&#46;<a class="elsevierStyleCrossRefs" href="#bib33">33&#44;88</a> Since a higher prevalence of gastric lesions and infection by <span class="elsevierStyleItalic">H&#46; pylori</span> has been demonstrated&#44; an increased incidence of cancer in the chagasic megaesophagus can be expected&#46;<a class="elsevierStyleCrossRef" href="#bib34">34</a>&#44; <a class="elsevierStyleCrossRef" href="#bib89">89</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib91">91</a></p><p id="para240" class="elsevierStylePara elsevierViewall">A review of 4&#44;690 necropsies and 24&#44;209 surgical specimens showed that the prevalence of malignant tumors of the large bowel was not higher in chagasic megacolon&#46;<a class="elsevierStyleCrossRef" href="#bib32">32</a> Other authors also showed no association between chagasic megacolon and an increased incidence of cancer&#46;<a class="elsevierStyleCrossRef" href="#bib33">33</a> Thus&#44; Chagas disease affects several gastrointestinal regions&#44; but there is no apparent relationship with the increased incidence of cancer and chagasic megacolon&#44; and the main causes of death in elderly chagasic patients are commonly related instead to heart disease&#46;<a class="elsevierStyleCrossRefs" href="#bib32">32&#44;33&#44;92</a></p></span></span><span id="cesec120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle130">SUMMARY</span><p id="para250" class="elsevierStylePara elsevierViewall">Chagas disease is an infectious disease that is described to mainly affect the central nervous system&#44; heart and gastrointestinal tract&#46; The objective of this review is to revise and summarize the main chronic gastrointestinal manifestations described in association with Chagas disease&#46;</p><p id="para260" class="elsevierStylePara elsevierViewall">Chagas disease is related to several chronic gastrointestinal disorders resulting from damage to both excitatory and inhibitory enteric motor innervations&#44; leading to megaesophagus&#44; megacolon&#44; megasmall intestine&#44; megagallbladder&#44; megacholedochus&#44; achalasia of the cardia&#44; changes in gastric receptive relaxation&#44; fast gastric emptying of liquid meals&#44; delayed gastric emptying of solid meals&#44; altered small intestine transit and impairment of colon and gallbladder motility&#46;</p><p id="para270" class="elsevierStylePara elsevierViewall">Chagas disease is also related to hypertrophy of the salivary glands&#44; increased saliva production&#44; decreased acid gastric production and altered small intestinal absorption&#46; In addition&#44; more peptic gastric lesions&#44; a higher incidence of <span class="elsevierStyleItalic">H&#46; pylori</span> infection&#44; a similar incidence of cancer in the colon&#44; a higher incidence of cancer in esophagus and altered distribution of the interstitial cells of Cajal in the megaesophagus and megacolon have also been demonstrated in association with Chagas disease&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:5 [
        0 => array:2 [
          "identificador" => "xpalclavsec1585057"
          "titulo" => "KEYWORDS&#58;"
        ]
        1 => array:2 [
          "identificador" => "cesec10"
          "titulo" => "INTRODUCTION"
        ]
        2 => array:3 [
          "identificador" => "cesec20"
          "titulo" => "DISCUSSION"
          "secciones" => array:9 [
            0 => array:2 [
              "identificador" => "cesec30"
              "titulo" => "The salivary gland manifestations of Chagas disease"
            ]
            1 => array:2 [
              "identificador" => "cesec40"
              "titulo" => "The esophagus and the lower esophageal sphincter manifestations of Chagas disease"
            ]
            2 => array:2 [
              "identificador" => "cesec50"
              "titulo" => "The stomach manifestations of Chagas disease"
            ]
            3 => array:2 [
              "identificador" => "cesec60"
              "titulo" => "The small intestine manifestations of Chagas disease"
            ]
            4 => array:2 [
              "identificador" => "cesec70"
              "titulo" => "The colonic manifestations of Chagas disease"
            ]
            5 => array:2 [
              "identificador" => "cesec80"
              "titulo" => "The gallbladder and the biliary tree manifestations of Chagas disease"
            ]
            6 => array:2 [
              "identificador" => "cesec90"
              "titulo" => "H&#46; pylori infection and Chagas disease"
            ]
            7 => array:2 [
              "identificador" => "cesec100"
              "titulo" => "The interstitial cells of Cajal and Chagas disease"
            ]
            8 => array:2 [
              "identificador" => "cesec110"
              "titulo" => "The incidence of gastrointestinal cancer and Chagas disease"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "cesec120"
          "titulo" => "SUMMARY"
        ]
        4 => array:1 [
          "titulo" => "REFERENCES"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2009-08-27"
    "fechaAceptado" => "2009-09-18"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "KEYWORDS&#58;"
          "identificador" => "xpalclavsec1585057"
          "palabras" => array:4 [
            0 => "Enteric nervous system"
            1 => "Gastrointestinal tract"
            2 => "Motility disorders"
            3 => "Chagas disease&#44; <span class="elsevierStyleItalic">Trypanosoma cruzi</span>"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:1 [
        "resumen" => "<span id="ceabs10" class="elsevierStyleSection elsevierViewall"><p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Chagas disease is an infectious disease caused by the protozoan <span class="elsevierStyleItalic">Trypanosoma cruzi</span>&#46; The disease mainly affects the nervous system&#44; digestive system and heart&#46; The objective of this review is to revise the literature and summarize the main chronic gastrointestinal manifestations of Chagas disease&#46; The chronic gastrointestinal manifestations of Chagas disease are mainly a result of enteric nervous system impairment caused by <span class="elsevierStyleItalic">T&#46; cruzi</span> infection&#46; The anatomical locations most commonly described to be affected by Chagas disease are salivary glands&#44; esophagus&#44; lower esophageal sphincter&#44; stomach&#44; small intestine&#44; colon&#44; gallbladder and biliary tree&#46; Chagas disease has also been studied in association with <span class="elsevierStyleItalic">Helicobacter pylori</span> infection&#44; interstitial cells of Cajal and the incidence of gastrointestinal cancer&#46;</p></span>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "REFERENCES"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "cebibsec10"
          "bibliografiaReferencia" => array:92 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nova tripanosomiaze humana"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              CRJ Chagas \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Memb Inst Oswaldo Cuz"
                        "fecha" => "1909"
                        "volumen" => "1"
                        "paginaInicial" => "159"
                        "paginaFinal" => "218"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chagas enteropathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              JV Campos \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              WL Tafuri \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/gut.14.11.910"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gut"
                        "fecha" => "1973"
                        "volumen" => "14"
                        "paginaInicial" => "910"
                        "paginaFinal" => "919"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4202602"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chagas&#8217; disease and Chagas&#8217; syndromes&#58; The pathology of American trypanosomiasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              F Koberle \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0065-308x(08)60472-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Adv Parasitol"
                        "fecha" => "1968"
                        "volumen" => "6"
                        "paginaInicial" => "63"
                        "paginaFinal" => "116"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4239747"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation and treatment of Chagas disease in the United States&#58; A systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              C Bern \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              SP Montgomery \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              BL Herwaldt \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              A Rassi Jr \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              JA Marin-Neto \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              RO Dantas \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.298.18.2171"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2007"
                        "volumen" => "298"
                        "paginaInicial" => "2171"
                        "paginaFinal" => "2181"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18000201"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The oral transmission of Chagas disease&#58; An acute form of infection responsible for regional outbreaks"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              PR Benchimol Barbosa \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2005.11.087"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2006"
                        "volumen" => "112"
                        "paginaInicial" => "132"
                        "paginaFinal" => "133"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16600406"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chagas disease&#58; A model of denervation in the study of digestive tract motility"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              UG Meneghelli \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Braz J Med Biol Res"
                        "fecha" => "1985"
                        "volumen" => "18"
                        "paginaInicial" => "255"
                        "paginaFinal" => "264"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3939103"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The lower esophageal sphincter in patients with Chagas disease with peristalsis and aperistalsis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              RO Dantas \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              RA Godoy \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Gastroenterol"
                        "fecha" => "1983"
                        "volumen" => "20"
                        "paginaInicial" => "13"
                        "paginaFinal" => "16"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6414443"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gastrointestinal manifestations of Chagas disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              RB Oliveira \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              LE Troncon \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              RO Dantas \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              UG Menghelli \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.1998.270_r.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "1998"
                        "volumen" => "93"
                        "paginaInicial" => "884"
                        "paginaFinal" => "889"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9647012"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The spectrum of esophageal motor disorders in Chagas disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              RB Oliveira \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              J Rezende Filho \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              RO Dantas \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              N Iazigi \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "1995"
                        "volumen" => "90"
                        "paginaInicial" => "1119"
                        "paginaFinal" => "1124"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7611209"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chagasic enteropathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              UG Meneghelli \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s0037-86822004000300012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Soc Bras Med Trop"
                        "fecha" => "2004"
                        "volumen" => "37"
                        "paginaInicial" => "252"
                        "paginaFinal" => "260"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15330067"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Basal motility of dilated and non-dilated sigmoid colon and rectum in Chagas disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              UG Meneghelli \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              RA Godoy \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              JF Macedo \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              RB Oliveira \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              LE Troncon \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              RO Dantas \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Gastroenterol"
                        "fecha" => "1982"
                        "volumen" => "19"
                        "paginaInicial" => "127"
                        "paginaFinal" => "132"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6821025"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impaired gastric accommodation to distension and rapid gastric emptying in patients with Chagas disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              RB Oliveira \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              LE Troncon \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              UG Meneghelli \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              W Padovan \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              RO Dantas \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              RA Godoy \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/BF01345301"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dig Dis Sci"
                        "fecha" => "1980"
                        "volumen" => "25"
                        "paginaInicial" => "790"
                        "paginaFinal" => "794"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6775917"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estudo do esvaziamento g&#225;strico de part&#237;culas s&#243;lidas diger&#237;veis na gastropatia chag&#225;sica cr&#244;nica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              FP Lopasso \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              PE Pinto Jr \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              JJ Gama-Rodrigues \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "GED"
                        "fecha" => "1985"
                        "volumen" => "4"
                        "paginaInicial" => "72"
                        "paginaFinal" => "78"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Abnormally rapid gastric emptying of an isosmotic liquid meal in patients with megaduodenum"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              LE Troncon \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              LR Aprile \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              RB Oliveira \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              N Iazigi \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1023/a:1026684418333"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dig Dis Sci"
                        "fecha" => "2000"
                        "volumen" => "45"
                        "paginaInicial" => "2145"
                        "paginaFinal" => "2150"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11215730"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Abnormal progression of a liquid meal through the stomach and small intestine in patients with Chagas disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              LE Troncon \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              RB Oliveira \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              LM Romanello \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              L Rosa-e-Silva \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              MC Pinto \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              N Iazigi \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/BF01308613"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dig Dis Sci"
                        "fecha" => "1993"
                        "volumen" => "38"
                        "paginaInicial" => "1511"
                        "paginaFinal" => "1517"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8344109"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Scintigraphic study of gallbladder emptying in chronic Chagas disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              LE Troncon \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              J Rezende Filho \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              N Iazigi \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Gastroenterol"
                        "fecha" => "1987"
                        "volumen" => "24"
                        "paginaInicial" => "157"
                        "paginaFinal" => "163"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3144963"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gallbladder motor function in chagasic patients with megacolon and&#47;or megaesophagus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              MG Villanova \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              UG Meneghelli \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              RO Dantas \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000199418"
                      "Revista" => array:6 [
                        "tituloSerie" => "Digestion"
                        "fecha" => "1987"
                        "volumen" => "36"
                        "paginaInicial" => "189"
                        "paginaFinal" => "194"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3111915"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Small bowel bacterial overgrowth syndrome in chagasic megajejunum&#58; Report of 2 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              LR Aprile \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              LE Troncon \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              UG Meneghelli \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              RB Oliveira \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Gastroenterol"
                        "fecha" => "1995"
                        "volumen" => "32"
                        "paginaInicial" => "71"
                        "paginaFinal" => "78"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8540804"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neuron count reevaluation in the myenteric plexus of chagasic megacolon after morphometric neuron analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              SJ Adad \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              CG Cancado \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              RM Etchebehere \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              VP Teixeira \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              UA Gomes \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              E Chapadeiro \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s004280000319"
                      "Revista" => array:6 [
                        "tituloSerie" => "Virchows Arch"
                        "fecha" => "2001"
                        "volumen" => "438"
                        "paginaInicial" => "254"
                        "paginaFinal" => "258"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11315622"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The enteric nervous system in chagasic and idiopathic megacolon"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              G Iantorno \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              G Bassotti \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              Z Kogan \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              CM Lumi \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              AM Cabanne \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              S Fisogni \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.pas.0000213371.79300.a8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Surg Pathol"
                        "fecha" => "2007"
                        "volumen" => "31"
                        "paginaInicial" => "460"
                        "paginaFinal" => "468"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17325489"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gallbladder neuron count in cholelithiasis patients with and without Chagas disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              E Crema \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              LB Ribeiro \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              SJ Adad \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              RM Ectchebehere \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              A Martins Junior \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              AA Silva \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s0037-86822007000100003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Soc Bras Med Trop"
                        "fecha" => "2007"
                        "volumen" => "40"
                        "paginaInicial" => "15"
                        "paginaFinal" => "17"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17486247"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Megacolon in Chagas disease&#58; A study of inflammatory cells&#44; enteric nerves&#44; and glial cells"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:5 [
                            0 => """
                              AB Silveira \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              EM Lemos \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              SJ Adad \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              R Correa-Oliveira \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              JB Furness \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.humpath.2007.01.020"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hum Pathol"
                        "fecha" => "2007"
                        "volumen" => "38"
                        "paginaInicial" => "1256"
                        "paginaFinal" => "1264"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17490721"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathophysiological significance of neuronal nitric oxide synthase in the gastrointestinal tract"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              T Takahashi \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00535-003-1094-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Gastroenterol"
                        "fecha" => "2003"
                        "volumen" => "38"
                        "paginaInicial" => "421"
                        "paginaFinal" => "430"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12768383"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of Chagas disease on nitric oxide-containing neurons in severely affected and unaffected intestine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              U Ribeiro Jr \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              AV Safatle-Ribeiro \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              A Habr-Gama \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              JJ Gama-Rodrigues \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              J Sohn \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              JC Reynolds \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/BF02237058"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dis Colon Rectum"
                        "fecha" => "1998"
                        "volumen" => "41"
                        "paginaInicial" => "1411"
                        "paginaFinal" => "1417"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9823808"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neurochemical coding of the enteric nervous system in chagasic patients with megacolon"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              AB Silveira \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              D D&#8217;Avila Reis \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              EC Oliveira \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              SG Neto \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              AO Luquetti \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              D Poole \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10620-006-9680-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dig Dis Sci"
                        "fecha" => "2007"
                        "volumen" => "52"
                        "paginaInicial" => "2877"
                        "paginaFinal" => "2883"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17385032"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Electrogastrography in patients with Chagas disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              J Rezende Filho \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              JM Rezende \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              JR Melo \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10620-005-2956-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dig Dis Sci"
                        "fecha" => "2005"
                        "volumen" => "50"
                        "paginaInicial" => "1882"
                        "paginaFinal" => "1888"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16187192"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A deficiency of interstitial cells of Cajal in chagasic megacolon"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              R Hagger \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              C Finlayson \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              F Kahn \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              R Oliveira \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              L Chimelli \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              D Kumar \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0165-1838(00)00076-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Auton Nerv Syst"
                        "fecha" => "2000"
                        "volumen" => "80"
                        "paginaInicial" => "108"
                        "paginaFinal" => "111"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10742548"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Interstitial cells of Cajal in patients with chagasic megacolon originating from a region of old endemicity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              RS Geraldino \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              AJ Ferreira \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              MA Lima \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              M Cabrine-Santos \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              E Lages-Silva \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              LE Ramirez \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pathophys.2005.12.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pathophysiology"
                        "fecha" => "2006"
                        "volumen" => "13"
                        "paginaInicial" => "71"
                        "paginaFinal" => "74"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16500095"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Peptic disease and helicobacter pylori are highly prevalent in patients with the indeterminate form of Chagas disease&#58; Report of 21 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              LC Oliveira \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              AG Buso \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              L Siqueira Filho \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              F Moraes \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              HA Oliveira \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              RM Oliveira \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s0036-46651997000400005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Inst Med Trop S&#227;o Paulo"
                        "fecha" => "1997"
                        "volumen" => "39"
                        "paginaInicial" => "209"
                        "paginaFinal" => "212"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9640783"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Interstitial cells of Cajal in chagasic megaesophagus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              MA Lima \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              M Cabrine-Santos \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              MG Tavares \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              GP Gerolin \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              E Lages-Silva \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              LE Ramirez \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.anndiagpath.2007.12.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Diagn Pathol"
                        "fecha" => "2008"
                        "volumen" => "12"
                        "paginaInicial" => "271"
                        "paginaFinal" => "274"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18620994"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Seroprevalence of Helicobacter pylori infection in chronic chagasic patients&#44; and in the rural and urban population from Uberl&#226;ndia&#44; Minas Gerais&#44; Brazil"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              RS Nascimento \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              SR Valente \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              LC Oliveira \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s0036-46652002000500003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Inst Med Trop Sao Paulo"
                        "fecha" => "2002"
                        "volumen" => "44"
                        "paginaInicial" => "251"
                        "paginaFinal" => "254"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12436163"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Megas and cancer&#46; Cancer of the large intestine in chagasic patients with megacolon"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              AC Meneses \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              MA Lopes \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              A Rocha \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              MC Fatureto \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              GP Lopes \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              ER Lopes \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Gastroenterol"
                        "fecha" => "1989"
                        "volumen" => "26"
                        "paginaInicial" => "13"
                        "paginaFinal" => "16"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2513795"
                             …1
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A retrospective study of histopathological findings in 894 cases of megacolon&#58; What is the relationship between megacolon and colonic cancer&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s0036-46652003000200007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Inst Med Trop S&#227;o Paulo"
                        "fecha" => "2003"
                        "volumen" => "45"
                        "paginaInicial" => "91"
                        "paginaFinal" => "93"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic gastritis and helicobacter pylori in digestive form of Chagas disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s0036-46651993000200002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Inst Med Trop Sao Paulo"
                        "fecha" => "1993"
                        "volumen" => "35"
                        "paginaInicial" => "117"
                        "paginaFinal" => "121"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib35"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of visceromegalies in necropsies carried out in Tri&#226;ngulo Mineiro from 1954 to 1988"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s0037-86821989000400008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Soc Bras Med Trop"
                        "fecha" => "1989"
                        "volumen" => "22"
                        "paginaInicial" => "211"
                        "paginaFinal" => "215"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib36"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sialorrhea&#46; A review of a vexing&#44; often unrecognized sign of oropharyngeal and esophageal disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Gastroenterol"
                        "fecha" => "2005"
                        "volumen" => "39"
                        "paginaInicial" => "89"
                        "paginaFinal" => "97"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib37"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The interrater reliability of physical signs in patients with eating disorders"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/eat.1094"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Eat Disord"
                        "fecha" => "2001"
                        "volumen" => "30"
                        "paginaInicial" => "343"
                        "paginaFinal" => "345"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib38"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Parotid gland enlargement in eating disorders&#58; An insensitive sign&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eat Weight Disord"
                        "fecha" => "2008"
                        "volumen" => "13"
                        "paginaInicial" => "79"
                        "paginaFinal" => "83"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib39"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lower esophageal sphincter pressure in Chagas disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/BF01536927"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dig Dis Sci"
                        "fecha" => "1990"
                        "volumen" => "35"
                        "paginaInicial" => "508"
                        "paginaFinal" => "512"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib40"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lower oesophageal sphincter response to pentagastrin in chagasic patients with megaoesophagus and megacolon"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/gut.21.2.85"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gut"
                        "fecha" => "1980"
                        "volumen" => "21"
                        "paginaInicial" => "85"
                        "paginaFinal" => "90"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib41"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The use of amyl nitrite as an antispasmodic in the roentgen examination of the gastrointestinal tract"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Roentgenol Radium Ther"
                        "fecha" => "1928"
                        "volumen" => "19"
                        "paginaInicial" => "44"
                        "paginaFinal" => "47"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib42"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The value of nitrites in cardiospasm &#40;achalasia of the esophagus&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Roentgenol Radium Ther"
                        "fecha" => "1940"
                        "volumen" => "43"
                        "paginaInicial" => "500"
                        "paginaFinal" => "508"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib43"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Achalasia of the cardia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0140-6736(89)90537-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1943"
                        "volumen" => "2"
                        "paginaInicial" => "353"
                        "paginaFinal" => "354"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib44"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Octil nitrite in achalasia of the cardia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1944"
                        "volumen" => "2"
                        "paginaInicial" => "848"
                        "paginaFinal" => "851"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib45"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of nitrates on los pressure in achalasia&#58; A potential therapeutic aid"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/gut.22.4.312"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gut"
                        "fecha" => "1981"
                        "volumen" => "22"
                        "paginaInicial" => "312"
                        "paginaFinal" => "318"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib46"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Isosorbide dinitrate and nifedipine treatment of achalasia&#58; A clinical&#44; manometric and radionuclide evaluation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "1982"
                        "volumen" => "83"
                        "paginaInicial" => "963"
                        "paginaFinal" => "969"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib47"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Radionuclide confirmation of the therapeutic value of isosorbide dinitrate in relieving the dysphagia in achalasia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00004836-198202000-00003"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Gastroenterol"
                        "fecha" => "1982"
                        "volumen" => "4"
                        "paginaInicial" => "17"
                        "paginaFinal" => "22"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib48"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of isosorbide dinitrate and atropine on the lower esophageal sphincter pressure in chagasic patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Physiol Pharmacol Latinoam"
                        "fecha" => "1988"
                        "volumen" => "38"
                        "paginaInicial" => "151"
                        "paginaFinal" => "158"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib49"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of nifedipine on the lower esophageal sphincter pressure in chagasic patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Braz J Med Biol Res"
                        "fecha" => "1986"
                        "volumen" => "19"
                        "paginaInicial" => "205"
                        "paginaFinal" => "209"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib50"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of the effects of sublingual isosorbide dinitrate and cardiomyotomy on esophageal emptying in patients with chagasic megaesophagus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Gastroenterol"
                        "fecha" => "1994"
                        "volumen" => "31"
                        "paginaInicial" => "47"
                        "paginaFinal" => "51"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib51"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of isosorbide dinitrate for the symptomatic treatment of patients with Chagas disease achalasia&#46; A double-blind&#44; crossover trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Braz J Med Biol Res"
                        "fecha" => "1991"
                        "volumen" => "24"
                        "paginaInicial" => "1093"
                        "paginaFinal" => "1098"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib52"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Short report&#58; Comparison of the effects of sublingual nifedipine and isosorbide dinitrate on oesophageal emptying in patients with chagasic achalasia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2036.1992.tb00565.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Aliment Pharmacol Ther"
                        "fecha" => "1992"
                        "volumen" => "6"
                        "paginaInicial" => "507"
                        "paginaFinal" => "512"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib53"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of isosorbide dinitrate on gastroesophageal reflux in healthy volunteers and patients with Chagas disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/BF02063962"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dig Dis Sci"
                        "fecha" => "1995"
                        "volumen" => "40"
                        "paginaInicial" => "177"
                        "paginaFinal" => "182"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib54"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nitric oxide as an inhibitory non-adrenergic non-cholinergic neurotransmitter"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/345346a0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nature"
                        "fecha" => "1990"
                        "volumen" => "345"
                        "paginaInicial" => "346"
                        "paginaFinal" => "347"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib55"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nitrergic transmission&#58; Nitric oxide as a mediator of non-adrenergic&#44; non-cholinergic neuro-effector transmission"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1440-1681.1992.tb00433.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Exp Pharmacol Physiol"
                        "fecha" => "1992"
                        "volumen" => "19"
                        "paginaInicial" => "147"
                        "paginaFinal" => "169"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib56"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Idiopathic achalasia and chagasic megaesophagus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00004836-198802000-00005"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Gastroenterol"
                        "fecha" => "1988"
                        "volumen" => "10"
                        "paginaInicial" => "13"
                        "paginaFinal" => "15"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib57"
              "etiqueta" => "57"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison between idiopathic achalasia and achalasia caused by Chagas disease&#58; A review on the publications about the subject"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s0004-28032003000200012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Gastroenterol"
                        "fecha" => "2003"
                        "volumen" => "40"
                        "paginaInicial" => "126"
                        "paginaFinal" => "130"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            57 => array:3 [
              "identificador" => "bib58"
              "etiqueta" => "58"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Are idiopathic and chagasic achalasia two different diseases&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1023/b:ddas.0000020486.71719.62"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dig Dis Sci"
                        "fecha" => "2004"
                        "volumen" => "49"
                        "paginaInicial" => "353"
                        "paginaFinal" => "360"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib59"
              "etiqueta" => "59"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Manometry and impedance characteristics of achalasia&#46; Facts and myths"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.mcg.0000248013.78020.b4"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Gastroenterol"
                        "fecha" => "2008"
                        "volumen" => "42"
                        "paginaInicial" => "266"
                        "paginaFinal" => "270"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            59 => array:3 [
              "identificador" => "bib60"
              "etiqueta" => "60"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Achalasia&#58; Physiology and etiopathogenesis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1442-2050.2006.00569.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dis Esophagus"
                        "fecha" => "2006"
                        "volumen" => "19"
                        "paginaInicial" => "213"
                        "paginaFinal" => "223"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            60 => array:3 [
              "identificador" => "bib61"
              "etiqueta" => "61"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patients with achalasia lack nitric oxide synthase in the gastro-oesophageal junction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2362.1993.tb01292.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Clin Invest"
                        "fecha" => "1993"
                        "volumen" => "23"
                        "paginaInicial" => "724"
                        "paginaFinal" => "728"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            61 => array:3 [
              "identificador" => "bib62"
              "etiqueta" => "62"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Achalasia&#58; What is the best treatment&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/1596-3519.55662"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Afr Med"
                        "fecha" => "2008"
                        "volumen" => "7"
                        "paginaInicial" => "141"
                        "paginaFinal" => "148"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            62 => array:3 [
              "identificador" => "bib63"
              "etiqueta" => "63"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Endoscopic and surgical treatments for achalasia&#58; A systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/SLA.0b013e31818e43ab"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2009"
                        "volumen" => "249"
                        "paginaInicial" => "45"
                        "paginaFinal" => "57"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            63 => array:3 [
              "identificador" => "bib64"
              "etiqueta" => "64"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical complications of Chagas&#8217; disease&#58; Megaesophagus&#44; achalasia of the pylorus&#44; and cholelithiasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/BF01659053"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Surg"
                        "fecha" => "1991"
                        "volumen" => "15"
                        "paginaInicial" => "198"
                        "paginaFinal" => "204"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            64 => array:3 [
              "identificador" => "bib65"
              "etiqueta" => "65"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fasting and food-stimulated plasma gastrin levels in chronic Chagas disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000199031"
                      "Revista" => array:6 [
                        "tituloSerie" => "Digestion"
                        "fecha" => "1984"
                        "volumen" => "29"
                        "paginaInicial" => "171"
                        "paginaFinal" => "176"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            65 => array:3 [
              "identificador" => "bib66"
              "etiqueta" => "66"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Plasma gastrin and gastric acid responses to insulin hypoglycemia in Chagas disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Braz J Med Biol Res"
                        "fecha" => "1985"
                        "volumen" => "18"
                        "paginaInicial" => "273"
                        "paginaFinal" => "278"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            66 => array:3 [
              "identificador" => "bib67"
              "etiqueta" => "67"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Abnormalities of interdigestive motility of the small intestine in patients with Chagas disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/BF01324944"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dig Dis Sci"
                        "fecha" => "1983"
                        "volumen" => "28"
                        "paginaInicial" => "294"
                        "paginaFinal" => "299"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            67 => array:3 [
              "identificador" => "bib68"
              "etiqueta" => "68"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of rectoanal inhibitory reflex in chagasic megacolon"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s0004-28032008000200007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Gastroenterol"
                        "fecha" => "2008"
                        "volumen" => "45"
                        "paginaInicial" => "128"
                        "paginaFinal" => "131"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            68 => array:3 [
              "identificador" => "bib69"
              "etiqueta" => "69"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effectiveness of anorectal manometry using the balloon method to identify the inhibitory recto-anal reflex for diagnosis of Hirschsprung&#8217;s disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s0104-42302005000600013"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Assoc Med Bras"
                        "fecha" => "2005"
                        "volumen" => "51"
                        "paginaInicial" => "313"
                        "paginaFinal" => "317"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            69 => array:3 [
              "identificador" => "bib70"
              "etiqueta" => "70"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Novel concepts in the diagnosis&#44; pathophysiology and management of idiopathic megabowel"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1463-1318.2007.01457.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Colorectal Dis"
                        "fecha" => "2008"
                        "volumen" => "10"
                        "paginaInicial" => "531"
                        "paginaFinal" => "538"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            70 => array:3 [
              "identificador" => "bib71"
              "etiqueta" => "71"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical treatment of Chagas megacolon&#46; Critical analysis of outcome in operative methods"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s0102-86502008000700015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Cir Bras"
                        "fecha" => "2008"
                        "volumen" => "23"
                        "paginaInicial" => "83"
                        "paginaFinal" => "92"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            71 => array:3 [
              "identificador" => "bib72"
              "etiqueta" => "72"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgery of chagasic megacolon"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/BF01659052"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Surg"
                        "fecha" => "1991"
                        "volumen" => "15"
                        "paginaInicial" => "188"
                        "paginaFinal" => "197"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            72 => array:3 [
              "identificador" => "bib73"
              "etiqueta" => "73"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of diverticular disease of the large bowel in non-chagasic and chagasic individuals with and without megacolon"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Gastroenterol"
                        "fecha" => "1986"
                        "volumen" => "23"
                        "paginaInicial" => "3"
                        "paginaFinal" => "8"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            73 => array:3 [
              "identificador" => "bib74"
              "etiqueta" => "74"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cholelithiasis in chronic Chagas disease patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Gastroenterol"
                        "fecha" => "1997"
                        "volumen" => "34"
                        "paginaInicial" => "222"
                        "paginaFinal" => "226"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            74 => array:3 [
              "identificador" => "bib75"
              "etiqueta" => "75"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Rocha A&#44; Almeida HO&#44; Teixeira VP&#44; Silva AM&#46; Prevalence of cholelithiasis in necropsies of patients with chronic Chagas&#8217; disease in the mining triangle&#8211;correlation with megaesophagus&#44; megacolon and cardiac insufficiency&#46; Arq Gastroenterol&#46; 1085&#59; 22&#44; 3-6"
                ]
              ]
            ]
            75 => array:3 [
              "identificador" => "bib76"
              "etiqueta" => "76"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical outcomes of eradication of helicobacter pylori in nonulcer dyspepsia in a population with a high prevalence of infection&#58; Results of a 12-month randomized&#44; double blind&#44; placebo-controlled study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10620-006-3090-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dig Dis Sci"
                        "fecha" => "2006"
                        "volumen" => "51"
                        "paginaInicial" => "89"
                        "paginaFinal" => "98"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            76 => array:3 [
              "identificador" => "bib77"
              "etiqueta" => "77"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis and treatment of chronic gastroparesis and chronic intestinal pseudo-obstruction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0889-8553(03)00028-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterol Clin North Am"
                        "fecha" => "2003"
                        "volumen" => "32"
                        "paginaInicial" => "619"
                        "paginaFinal" => "658"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            77 => array:3 [
              "identificador" => "bib78"
              "etiqueta" => "78"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Interstitial cells of Cajal in the gut&#8211;a gastroenterologist&#8217;s point of view"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3748/wjg.14.6285"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Gastroenterol"
                        "fecha" => "2008"
                        "volumen" => "14"
                        "paginaInicial" => "6285"
                        "paginaFinal" => "6288"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            78 => array:3 [
              "identificador" => "bib79"
              "etiqueta" => "79"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is constipation caused by a loss of colonic interstitial cells of Cajal&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0016-5085(03)00829-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "2003"
                        "volumen" => "125"
                        "paginaInicial" => "264"
                        "paginaFinal" => "265"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            79 => array:3 [
              "identificador" => "bib80"
              "etiqueta" => "80"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Interstitial cells of Cajal in health and disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2982.2008.01109.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurogastroenterol Motil"
                        "fecha" => "2008"
                        "volumen" => "20"
                        "paginaInicial" => "54"
                        "paginaFinal" => "63"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            80 => array:3 [
              "identificador" => "bib81"
              "etiqueta" => "81"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Decreased interstitial cells of Cajal in the sigmoid colon of patients with slow transit constipation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00384-003-0577-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Colorectal Dis"
                        "fecha" => "2004"
                        "volumen" => "19"
                        "paginaInicial" => "467"
                        "paginaFinal" => "473"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            81 => array:3 [
              "identificador" => "bib82"
              "etiqueta" => "82"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pan-colonic decrease in interstitial cells of Cajal in patients with slow transit constipation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/gut.51.4.496"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gut"
                        "fecha" => "2002"
                        "volumen" => "51"
                        "paginaInicial" => "496"
                        "paginaFinal" => "501"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            82 => array:3 [
              "identificador" => "bib83"
              "etiqueta" => "83"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Alterations in the density of interstitial cells of Cajal in achalasia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10620-007-0053-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dig Dis Sci"
                        "fecha" => "2008"
                        "volumen" => "53"
                        "paginaInicial" => "1488"
                        "paginaFinal" => "1492"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            83 => array:3 [
              "identificador" => "bib84"
              "etiqueta" => "84"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reduction of interstitial cells of Cajal &#40;ICC&#41; associated with neuronal nitric oxide synthase &#40;n-NOS&#41; in patients with achalasia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.2007.01667.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2008"
                        "volumen" => "103"
                        "paginaInicial" => "856"
                        "paginaFinal" => "864"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            84 => array:3 [
              "identificador" => "bib85"
              "etiqueta" => "85"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Interstitial cells of Cajal reduce in number in recto-sigmoid Hirschsprung&#8217;s disease and total colonic aganglionosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.neulet.2009.01.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurosci Lett"
                        "fecha" => "2009"
                        "volumen" => "451"
                        "paginaInicial" => "208"
                        "paginaFinal" => "211"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            85 => array:3 [
              "identificador" => "bib86"
              "etiqueta" => "86"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Distribution of interstitial cells of Cajal and nitrergic neurons in normal and diabetic human appendix"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2982.2007.01040.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurogastroenterol Motil"
                        "fecha" => "2008"
                        "volumen" => "20"
                        "paginaInicial" => "349"
                        "paginaFinal" => "357"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            86 => array:3 [
              "identificador" => "bib87"
              "etiqueta" => "87"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic intestinal pseudoobstruction associated with altered interstitial cells of Cajal networks"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00005176-200304000-00016"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Gastroenterol Nutr"
                        "fecha" => "2003"
                        "volumen" => "36"
                        "paginaInicial" => "492"
                        "paginaFinal" => "497"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            87 => array:3 [
              "identificador" => "bib88"
              "etiqueta" => "88"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Endoscopy in megaesophagus&#46; Prospective study of 600 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Gastroenterol"
                        "fecha" => "1985"
                        "volumen" => "22"
                        "paginaInicial" => "53"
                        "paginaFinal" => "62"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            88 => array:3 [
              "identificador" => "bib89"
              "etiqueta" => "89"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association of Helicobacter pylori infection with gastric carcinoma&#58; A meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.1999.01360.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "1999"
                        "volumen" => "94"
                        "paginaInicial" => "2373"
                        "paginaFinal" => "2379"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            89 => array:3 [
              "identificador" => "bib90"
              "etiqueta" => "90"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increased prevalence of precancerous changes in relatives of gastric cancer patients&#58; Critical role of H&#46; pylori"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0016-5085(00)70410-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "2000"
                        "volumen" => "118"
                        "paginaInicial" => "22"
                        "paginaFinal" => "30"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            90 => array:3 [
              "identificador" => "bib91"
              "etiqueta" => "91"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of Helicobacter pylori and prevention of gastric cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1443-9573.2007.00315.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dig Dis"
                        "fecha" => "2008"
                        "volumen" => "9"
                        "paginaInicial" => "8"
                        "paginaFinal" => "13"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            91 => array:3 [
              "identificador" => "bib92"
              "etiqueta" => "92"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Basic causes of death in elderly patients with Chagas disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Bras Cardiol"
                        "fecha" => "1989"
                        "volumen" => "52"
                        "paginaInicial" => "75"
                        "paginaFinal" => "78"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/18075932/0000006400000012/v1_202212060833/S1807593222025121/v1_202212060833/en/main.assets"
  "Apartado" => null
  "PDF" => "https://static.elsevier.es/multimedia/18075932/0000006400000012/v1_202212060833/S1807593222025121/v1_202212060833/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222025121?idApp=UINPBA00004N"
]

Article information

ISSN: 18075932
Original language: English

DOI:10.1590/S1807-59322009001200013

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	1	0	1
2024 October	24	21	45
2024 September	16	20	36
2024 August	25	19	44
2024 July	24	27	51
2024 June	24	17	41
2024 May	27	16	43
2024 April	40	11	51
2024 March	40	13	53
2024 February	44	16	60
2024 January	30	20	50
2023 December	21	21	42
2023 November	17	18	35
2023 October	10	15	25
2023 September	12	18	30
2023 August	10	9	19
2023 July	8	12	20
2023 June	17	16	33
2023 May	39	6	45
2023 April	38	1	39
2023 March	28	0	28
2023 February	27	1	28
2023 January	23	2	25
2022 December	20	0	20

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter