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Oesophageal manometry in early and definite systemic sclerosis
Paolo Airò1, Domenico Della Casa, Elisabetta Danieli
1The Rheumatology, Allergology and Clinical Immunology Service, Spedali Civili and University, Brescia, Italy. airo@bresciarematologia.it
Clinical Rheumatology
|December 14, 2004
Summary
Oesophageal dysfunction is common in early systemic sclerosis (SSc), even in asymptomatic patients. Oesophageal manometry detects these abnormalities, which correlate with disease severity and lung function.
Area of Science:
- Rheumatology
- Gastroenterology
- Clinical Medicine
Background:
- Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by fibrosis affecting the skin and internal organs.
- Oesophageal involvement is a common manifestation of SSc, impacting quality of life and potentially leading to complications.
- Early diagnosis and characterization of SSc-related organ involvement are crucial for timely management.
Purpose of the Study:
- To evaluate oesophageal dysfunction in patients with early systemic sclerosis (SSc).
- To compare oesophageal dysfunction in early SSc with definite SSc.
- To correlate oesophageal abnormalities with other clinical and serological features of SSc.
Main Methods:
- Retrospective analysis of oesophageal manometry results in 181 patients with SSc.
- Patients were classified using the 2001 LeRoy and Medsger criteria and the 1980 American College of Rheumatology (ACR) criteria.
- Correlation of oesophageal findings with disease subset, autoantibody status, and pulmonary function tests (forced vital capacity - FVC).
Main Results:
- Peristaltic abnormalities in the oesophageal body were significantly more frequent in SSc patients fulfilling ACR criteria (SSc ACR+) compared to those not fulfilling criteria (SSc ACR-) (73/125 vs 13/56, p < 0.0001).
- Oesophageal abnormalities were more severe in patients with more advanced disease and in those with anti-Scl-70 antibodies.
- Lower oesophageal sphincter (LES) abnormalities were correlated with reduced forced vital capacity (FVC), suggesting a link to lung involvement.
Conclusions:
- Oesophageal manometry can identify significant oesophageal dysfunction in patients with early SSc, including those without symptoms and not meeting ACR criteria.
- The severity of oesophageal dysfunction correlates with disease progression and specific autoantibodies.
- The association between LES abnormalities and FVC suggests a potential shared pathophysiological mechanism between oesophageal and pulmonary manifestations in SSc.
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