[Esophageal mucosal lesions and scleroderma: prevalence, symptoms and risk factors]

Scleroderma or systemic sclerosis (Ssc) is a connective tissue disease which frequently involves the esophagus. Motility disorders, such as a low pressure level in the Lower Esophageal Sphincter (LES), and disturbed esophageal peristalsis cause a higher acid exposition and mucosal damage. We study twenty Ssc patients using computerized esophageal manometry, endoscopy and clinical interview looking for prevalence of symptoms, esophageal dysmotility and erosive esophagitis, and trying to find risk factors involved in esophageal damage. Esophagitis was found in 40% of patients. Clinical presentation (diffuse or limited), age and time since diagnosis wer'nt accurate predictors of esophageal involvement. Symptoms such as dysphagia and heartburn had not any significant difference in those with and without esophagitis, so 25% of patients with mucosal damage had no symptoms and 60% of healthy ones complained about them. LES values were not significantly different between the two groups, with a great degree of overlap with normal values. Disturbed motility pattern of aperistalsis was the only factor that identified high and low risk groups for esophagitis, with a high statistical significance (p > 0.02). Mucosal sensitivity in severe esophagitis and pharyngeal and upper esophageal functions were normal in all patients. Impaired peristalsis, with a delayed clearance of acid is the most important factor for mucosal damage in scleroderma. Symptoms of gastroesophageal reflux are not a reliable predictor of erosive esophagitis. Endoscopy should be the usual method of diagnosis, in order to make a proper use of therapeutic weapons.