Detection of early asymptomatic esophageal dysfunction in systemic sclerosis using a new scintigraphic grading method

Area of Science:

• Gastroenterology
• Rheumatology
• Medical Imaging

Background:

• Systemic sclerosis (SSc) frequently affects the esophagus, leading to dysmotility and gastroesophageal reflux.
• Accurate assessment of esophageal involvement is crucial for managing SSc patients.

Purpose of the Study:

• To screen SSc patients for esophageal disease using scintigraphy.
• To introduce and validate a new grading system for esophageal dysmotility.
• To correlate dysphagia symptoms with scintigraphy-detected hypomotility.

Main Methods:

• Esophageal scintigraphy with a semisolid bolus was performed on 301 SSc patients.
• A novel grading system (0-4) quantified esophageal dysfunction and gastroesophageal reflux.
• Symptoms of dysphagia were retrospectively analyzed in a subset of patients.

Main Results:

• 82% of SSc patients exhibited esophageal hypomotility.
• Gastroesophageal reflux was present in 28% of patients.
• Dysphagia symptoms correlated with higher grades of dysmotility (grades 3-4), but 60% of patients with grades 1-2 had no dysphagia.

Conclusions:

• Esophageal scintigraphy is a valuable noninvasive tool for detecting asymptomatic esophageal disease in SSc.
• Patient symptoms may not reliably indicate the presence or severity of esophageal dysfunction.
• The new grading system aids in staging esophageal disease and facilitates follow-up studies.