Authors: LISI Daniele (Ultrasound) BIANCANIELLO Francesca (Endoscopy) RIPANI Cristina (Hospital Management) D'ALBA Lucia (Esophageal Manometry) DI CERBO Arcangelo (Pathology) D'OVIDIO Valeria (Pneumatic Dilation)

This is the case of a 33-year-old woman, born in Brazil, managed by a multidisciplinary team. The patient was referred for progressive dysphagia and weight loss. Clinical examination, combined with bedside ultrasound, revealed esophageal dilation from the neck to the epigastric region. Endoscopy revealed severe dietary impaction and, after prolonged fasting, megaesophagus (histological examination: no eosinophilic esophagitis). During hospitalization, the patient underwent esophageal manometry, which confirmed achalasia without increased lower esophageal sphincter pressure.

All these findings, combined with the grandmother's history of Chagas cardiomyopathy, supported the hypothesis of Chagas disease, although not confirmed by PCR (high sensitivity in the acute phase, 80%-95%, but lower in the chronic phase, 40%-65%).

Finally, the case was treated with endoscopic balloon dilation, resulting in resolution of symptoms and weight gain.