Esophageal motor dysfunction in systemic sclerosis: clinical predictors and a risk stratification model

High-resolution esophageal manometry (HRM) allows for precise evaluation of esophageal motor abnormalities in patients with systemic sclerosis (SSc), but data from Latin America are limited. The aim of this study was to determine the prevalence and clinical predictors of esophageal motor dysfunction in patients with SSc, using the Chicago Classification from 2010 to 2022.

We conducted a retrospective cross-sectional study including adult patients with a confirmed diagnosis of SSc who underwent HRM between 2010 and 2022. Studies were performed using Sandhill Scientific (now Diversatek Healthcare) or Medtronic systems and interpreted according to the version of the Chicago Classification available at the time. Esophageal motor function was categorized as absent contractility, ineffective esophageal motility, or normal motility. Demographic, clinical, and serological data were collected from medical records. Logistic regression was used to identify predictors, and a clinical prediction score was developed.

Among 127 patients (mean age 56 years, 93% female), 73% had esophageal motor dysfunction. In multivariable analysis, the presence of regurgitation, digital pitting scars, and diffusion capacity for carbon monoxide ≤80% were independently associated with motor dysfunction. A clinical prediction score combining these three factors stratified the probability of esophageal involvement from 40.9% (score 0) to 93.8% (score 3). The model showed good performance in terms of discrimination and calibration.

Esophageal motor dysfunction is highly prevalent in patients with SSc and can be predicted using simple clinical variables. This tool may help guide diagnostic evaluation, particularly in healthcare settings with limited access to esophageal manometry.