Exploring esophageal vasculopathy in systemic sclerosis through left gastric artery Doppler ultrasound: a pilot study

Systemic sclerosis (SSc) is characterized by immune dysregulation, fibrosis, and vasculopathy of the skin and internal organs. Vasculopathy is considered the fundamental pathogenetic determinant, and the gastrointestinal (GI) tract-particularly the esophagus-is among the most frequently involved organs even if its involvement is likely underestimated due to the lack of adequate screening tools. The left gastric artery (LGA) is a small vessel supplying the lower esophageal sphincter. This study aimed to assess the feasibility of Doppler ultrasound (DUS) evaluation of the LGA, and to explore whether LGA hemodynamic parameters may represent a surrogate marker of upper GI vasculopathy in SSc.

A total of 38 SSc patients (ACR/EULAR 2013 classification criteria) and 25 healthy controls were enrolled. Subjects underwent DUS of the LGA performed by a single expert operator. The size and arterial blood flow of the LGA were evaluated, and Doppler parameters were measured and calculated.

In 49/63 subjects (78%), among which 29 patients and 20 healthy controls, LGA was clearly visualized. Among the Doppler parameters, only RI differed significantly between groups, being higher in SSc patients (0.81 ± 0.04 vs 0.77 ± 0.08; mean difference 0.04; p = 0.041; 95% CI 0.001-0.08; Cohen's d = 0.620).

LGA can be visualized using DUS in a substantial proportion of subjects. The observed increase in RI in SSc patients is a preliminary finding that may reflect underlying vasculopathy, and is in line with the vascular involvement which characterizes the disease, although its clinical significance remains to be established. Given the small sample size, the exploratory nature of this finding and potential confounders, larger studies are needed to confirm these preliminary results and to determine whether age- and sex-specific cutoff values may be clinically meaningful. Key Points • Doppler ultrasound allows feasible assessment of the left gastric artery in the majority of patients with systemic sclerosis. • Systemic sclerosis patients showed higher left gastric artery resistive index values, suggesting a possible association with upper gastrointestinal vasculopathy. • These preliminary findings support left gastric artery Doppler ultrasound as a technique worth further study in systemic sclerosis, warranting larger validation cohorts to confirm their clinical relevance.