International Journal of General Medicine (May 2024)
Journey into the Esophageal Complications: Decoding Systemic Sclerosis with Cutting-Edge Endoscopy, Manometry, and Ambulatory pH-Study
Abstract
Omer Ahmed Hamad Amin,1 Raouf Rahim Mirza,2 Hiwa Abubakr Hussein,2 Zhikal Omar Khudhur,3 Harem Khdir Awla,4 Shukur Wasman Smail4,5 1Department of Rheumatology, Ranya Teaching Hospital, Ministry of Health, Ranya, Kurdistan Region, Iraq; 2College of Medicine, University of Sulaimani, Sulaimani, Kurdistan Region, Iraq; 3Biology Education Department, Tishk International University, Erbil, Iraq; 4Department of Biology, College of Science, Salahaddin University, Erbil, Kurdistan Region, Iraq; 5Department of Medical Microbiology, College of Science, Cihan University-Erbil, Kurdistan Region, IraqCorrespondence: Shukur Wasman Smail, Department of Biology, College of Science, Salahaddin University, Erbil, Kurdistan Region, Iraq, Tel +9647504491092, Email [email protected]: Systemic Sclerosis (SSc) is a rare connective tissue disorder characterized by autoimmunity, fibrosis, and vasculopathy that affects the skin and internal organs, including the gastrointestinal tract, particularly the esophagus. This article highlights the characteristics and clinical symptoms of esophageal involvement in patients with SSc.Patients and Methods: This study was conducted between November 2022 to August 2023, including 26 already diagnosed cases of SSc in the Department of Rheumatology and Rehabilitation and Kurdistan Center for Gastroenterology and Hepatology-Sulaymaniyah, Iraq. Esophageal involvement was investigated using esophageal manometry, esophagogastroduodenoscopy (EGD), and 24-hour impedance-pH monitoring.Results: Females were significantly predominant (P = 0.019) regarding the symptoms; 76.9% of the patients had heart burn, 76.9% dysphagia, 73.1% water brush, and 69.2% regurgitation. In total, 69.2% of the patients showed erosive gastrointestinal reflux disease (GERD) on EGD, 76.9% had decreased lower esophageal sphincter pressure (DLESP) and decreased distal esophageal peristaltic contractions (DDEPC) on esophageal manometry, and 84.6% had reflux on pH monitoring. Raynaud’s phenomenon is the most common and typically the earliest clinical manifestation of SSc. The presence of erosive GERD was found to significantly increase the risk of developing dysphagia (B = 4.725, P = 0.014, OR = 3.482) and regurgitation (B = 3.521, P = 0.006, OR = 4.030).Conclusion: It is crucial to take gender-specific considerations into account when diagnosing and managing esophageal complications in patients with systemic sclerosis (SSc). Additionally, employing various diagnostic assessments to detect esophageal involvement during SSc is essential. Erosive GERD has been identified as a risk factor that contributes to the development of dysphagia and regurgitation in individuals with SSc.Keywords: esophageal involvement, esophageal manometry, esophagogastroduodenoscopy, 24-hour Impedance-pH Monitoring, systemic sclerosis
