Esophagogastric junction in systemic sclerosis: A study with the functional lumen imaging probe

Area of Science:

• Gastroenterology
• Rheumatology
• Medical Imaging

Background:

• Systemic sclerosis (SSc) often causes esophageal dysfunction, including gastro-esophageal reflux and dysphagia, due to smooth muscle fibrosis and atrophy.
• Esophagogastric junction (EGJ) distensibility, assessed by Functional Lumen Imaging Probe (FLIP), may offer a more sensitive measure of sphincter function than traditional manometry.
• Understanding EGJ distensibility in SSc is crucial for accurate diagnosis and management of related esophageal symptoms.

Purpose of the Study:

• To characterize and compare EGJ distensibility parameters in patients with systemic sclerosis (SSc).
• To evaluate the utility of FLIP in assessing EGJ function in SSc patients experiencing reflux or dysphagia.

Main Methods:

• Investigated 12 SSc patients (median age 53, disease duration 1-20 years) with reflux or dysphagia using EGJ distensibility testing.
• Compared SSc patients with 11 healthy volunteers (HV) (median age 53).
• Analyzed EGJ pressure and minimum diameter during ramp distension to determine distensibility.

Main Results:

• SSc patients exhibited significantly lower EGJ yield pressure (median 4.0 mmHg) compared to HV (median 6.2 mmHg) (P=.007).
• The pressure-strain elastic modulus was also lower in SSc patients (median 1.73 kPa) than in HV (median 2.41 kPa) (P=.03).
• These results indicate reduced resistance to distension in the EGJ of SSc patients.

Conclusions:

• Patients with SSc experiencing reflux and dysphagia demonstrate significantly reduced resistance to EGJ distension.
• EGJ distensibility assessment using FLIP provides valuable insights into esophageal smooth muscle dysfunction in SSc.
• This study underscores the importance of evaluating EGJ distensibility for managing SSc-related esophageal complications.