Abnormal esophageal motility during a solid test meal in systemic sclerosis—detection even in very early disease and association with disease progression

Abstract

Objective This study assessed whether high‐resolution manometry (HRM) with a test meal can detect clinically relevant, abnormal motility already in very early systemic sclerosis (SSc) and whether this finding is associated with subsequent disease progression. Methods This prospective, longitudinal cohort study recruited 68 consecutive SSc patients (group #1: 32 established disease (ACR, American College of Rheumatology /EULAR, The European League against Rheumatism 2013 and ACR 1980 criteria fulfilled); group #2: 24 early disease (only ACR/EULAR 2013 fulfilled); group #3: 12 very early disease (clinical expert diagnosis of SSc) and 72 healthy controls. HRM evaluated esophageal motility for water swallows and a solid test meal. Results Systemic sclerosis patients had less frequent effective esophageal contractions during the test meal compared to healthy controls even in very early disease (0.15, 1.0, 2.1 per minute for groups #1, #2, and #3, vs 2.5 per minute in health; P < 0.001, P < 0.001, and P < 0.0085, respectively). Ineffective motility at HRM was associated with a higher modified Rodnan skin score at baseline. Moreover, at mean 18 (10‐31) months of follow‐up, the presence of ineffective motility at baseline was associated with progression of skin disease (P = 0.01). Cox proportional hazard regression analysis identified hypotensive peristalsis in the test meal (<15% effective solid swallows) and low distal contractile integral (DCI; <400 mm Hg·cm·s) as predictors for skin aggravation, but not for new organ involvement. Conclusion Ineffective motility during a test meal is present already in patients with very early SSc. Findings on HRM studies are associated with disease severity at baseline, and low percentage of effective swallows in test meal and low mean DCI are both predictors of skin progression during follow‐up.

Prospective serial diagnostic study: the effects of position and provocative tests on the diagnosis of oesophageal motility disorders by high‐resolution manometry

“…Absent peristalsis was observed in single water swallows in both positions in 28 individuals. Zurich University is a referral centre for systemic sclerosis and the proportion of patients with aperistalsis is higher than would otherwise be expected …”

“…Although the association of ineffective motility with symptoms is weak, 39 this disorder impairs oesophageal clearance, [40][41][42] is frequently present in erosive oesophagitis, [40][41][42] and its presence contributes to the diagnosis of gastro-oesophageal reflux disease by the Lyon classification. 43 The presence of ineffective motility and absent motility are also diagnostic markers of systemic sclerosis that are associated with disease severity 31,44,45 and predict systemic sclerosis progression even at very early stages of disease. 31 Reference values for oesophageal motility in the upright position are available.…”

“…43 The presence of ineffective motility and absent motility are also diagnostic markers of systemic sclerosis that are associated with disease severity 31,44,45 and predict systemic sclerosis progression even at very early stages of disease. 31 Reference values for oesophageal motility in the upright position are available. 14,16,18,19,32 Based on data published by our group, 19,23 one option to harmonise the results and avoid over-diagnosis of clinically irrelevant ineffective motility would be to reduce the fraction of effective contractions on single water swallows required to define normal motility in the upright position from 50% to 20% while retaining the current threshold (DCI 450 mm Hg⋅cm⋅sec).…”

Diagnostic yield of adding solid food swallows during high‐resolution manometry in esophageal motility disorders

“…[1][2][3] Previous published data suggest that viscous or solid meal tests could increase the diagnostic yield of HRM for the detection of motility disorders. [4][5][6][7][8][9][10] Recently, Hollenstein et al 10 validated parameters in healthy volunteers for the assessment of esophageal motility during solid meal test, and developed a classification of motility disorders named 'Chicago classification adapted for solids' (CC-S). The CC-S was used in the evaluation of a cohort of 750 patients with dysphagia, reflux or other symptoms and the authors demonstrated that solid meal test increased the detection of esophageal motility disorders in patients with esophageal symptoms.…”

“…The CC-S was used in the evaluation of a cohort of 750 patients with dysphagia, reflux or other symptoms and the authors demonstrated that solid meal test increased the detection of esophageal motility disorders in patients with esophageal symptoms. 11 As the utility of solid meal test in the daily practice is still being evaluated and there are studies with some incongruent results, [4][5][6][7][8][9][10][11] this study was performed aiming to identify the clinical value of adding solid food swallows (SFS) during esophageal HRM.…”