Oesophageal function was studied by radiography and manometry in fifty-one patients with progressive system sclerosis (PSS), fourteen patients with morphoea, twelve patients with Raynaud's disease and twenty-one normal subjects. Upper oesophageal sphincter pressure was not affected. Peristaltic contractions of the upper third of the oesophagus were significantly decreased in PSS and morphoea, but the lower two-thirds were affected only in PSS. Lower oesophageal sphincter pressure was significantly decreased in PSS but was normal in morphoea and Raynaud's disease. There was a significant correlation between oesophageal dysfunction and the duration of PSS. Manometry was better than radiography at detecting motor abnormalities, with a positivity of 86% compared with 66% for radiography. Oesophageal manometry should be employed routinely in the investigation of patients with suspected PSS or morphoea.

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In 25 patients with progressive systemic sclerosis esophageal involvement was studied prospectively by analysing subjective symptoms and radiological and manometric criteria. In all patients abnormal motility could be demonstrated by X-ray and/or manometry: radiologically in 18 (72%), manometrically in 22 (88%) cases. Dysphagia was present only in 11 patients (44%). Six patients (24%) had no subjective symptoms in spite of severe objective esophageal abnormalities. Therefore, the absence of esophageal symptoms does not exclude advanced affliction of the esophagus. To determine the pathogenesis of esophageal dysfunction the effects of 3.5 microgram/kg carbachol and of 0.6 microgram/kg pentagastrin i.m. on the lower esophageal sphincter pressure (LESP), on the amplitude and on the duration of peristaltic esophageal contractions were studied at random in 12 of the patients and 12 normal controls. The results suggest a primary myogenic genesis of the motor abnormalities by atrophy and sclerosis of esophageal smooth muscle.