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

To screen patients with systemic sclerosis (SSc) for esophageal disease and to demonstrate a new system of grading dysmotility; to determine the relationship between the symptom of dysphagia and the degree of hypomotility shown by scintigraphy.

301 patients with SSc were studied by esophageal scintigraphy using a semisolid orally ingested bolus to detect esophageal dysfunction and gastroesophageal reflux. A new system of grading was used to quantitate the degree of dysfunction, ranging from grade 0 (normal) to grade 4 (severe abnormality).

246 (82%) patients in the study population had evidence of esophageal hypomotility. Gastroesophageal reflux was noted in 83 (28%) patient. The largest number of patients (33%) were found to have grade 2 abnormalities. The number of patients with reflux decreased with increasing severity of grade, from grade 2 to grade 4 (35 to 13%). A retrospective study of the symptoms of 50 of the total study population showed that increasing severity of grade correlated with increasing mean duration of SSc. There was no significant relationship between disease subset and the presence or severity of esophageal hypomotility. 60% of patients in grades 1 and 2 (i.e. with observed dysmotility shown on scintigraphy) had no symptoms of dysphagia. In the more severe grades (scan grades 3 and 4), symptoms of dysphagia correlated with increase in grade.

Symptoms may be unreliable in judging the presence of extent of esophageal disease in SSc. Esophageal scintigraphy is a useful noninvasive screening test for the detection of asymptomatic disease. The new grading system provides information that rapidly identifies the stage of esophageal disease and gives comparative data for followup and interventional studies.