Esophageal motility disorders in systemic sclerosis

Abstract

Systemic sclerosis is an autoimmune disease characterized by vasculopathy and tissue fibrosis. Esophageal disorders are often associated. The diagnosis is confirmed and characterized by high-resolution esophageal manometry (HRM). This study aims to describe the esophageal motility disorders found by high-resolution esophageal manometry, in patients followed for systemic sclerosis. An observational study carried out between April 2018 and January 2020, including 23 patients with systemic sclerosis according to EULAR/ACR 2013 criteria, referred for high-resolution esophageal manometry. We used the Chicago V3.0 classification to order esophageal motor disorders into two categories: major and minor disorders of peristalsis. Four parameters were analyzed: lower esophageal sphincter resting pressure (LES), distal latency (DL) and distal contractile integral (DCI) and integrated relaxation pressure (IRP). IRP was normal in all cases. The digestive symptoms were: gastroesophageal reflux in 10 cases (43.4%) and dysphagia in 6 cases (26.2%). Seven patients were asymptomatic (30.4%). HRM revealed a major disorder of esophageal peristalsis in 14 cases (60.9%), minor disorders in 4 patients (17.4%) and was normal in 5 cases (21.7%). There was; hypotonia of the lower esophageal sphincter (LES) with absent contractility in 8 cases (44.5%), only absence of contractility in 6 cases (33.3%), hypotonia of the lower esophageal sphincter (LES) with ineffective motility in 4 cases (22.2%). High-resolution esophageal manometry should be considered in all patients with systemic sclerosis even in the absence of digestive symptoms. In our series, motility disorders were present in 78.3% of cases.

Keywords

• esophageal dysmotility
• dysphagia
• scleroderma
• high-resolution manometry