Esophageal involvement and pulmonary manifestations in systemic sclerosis

Marie, I.; Dominique, S.; Lévesque, H.; Ducrotté, Philippe; Denis, Philippe; Hellot, Marie‐France; Courtois, H

doi:10.1002/1529-0131(200108)45:4<346::aid-art347>3.0.co;2-l

Cited by 195 publications

(141 citation statements)

References 59 publications

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“…Impairment of the motor function of the esophagus has been linked to more severe reflux and possible recurrent episodes of micro aspiration and lung damage. For example, Marie et al (15) studied 43 patients with scleroderma. These authors divided the patients in three groups according to the degree of esophageal dismotility.…”

Section: Does Impairment In the Esophageal Motility Have Influence Onmentioning

confidence: 99%

“…It is reasonable to suggest that the esophageal dysmotility can cause or contribute to the development of pulmonary complications through repeated episodes of micro aspiration. For instance, in a prospective study of patients with systemic sclerosis, Marie et al (15) identified a correlation between the degree of esophageal dysmotility (as shown by manometry) and evidence of ILD both by pulmonary function tests and high resolution computed tomography. In addition, at 2 year follow-up, patients with severe esophageal dysmotility had a faster deterioration of lung function and a higher frequency of ILD on high resolution computed tomography scans, suggesting that GERD may be one of the contributing factors of ILD in patients with systemic sclerosis.…”

Section: Is Surgical Treatment Effective and Does It Alter The Naturamentioning

confidence: 99%

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Interstitial lung disease and gastroesophageal reflux disease: key role of esophageal function tests in the diagnosis and treatment

Soares

Forsythe

Hogarth

et al. 2011

Arq. Gastroenterol.

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-Context -Gastroesophageal reflux disease (GERD) is common in patients with respiratory disorders and interstitial lung fibrosis from diverse disease processes. However, a cause-effect relationship has not been well demonstrated. It is hypothesized that there might be more than a coincidental association between GERD and interstitial lung damage. There is still confusion about the diagnostic steps necessary to confirm the presence of GERD, and about the role of effective control of GERD in the natural history of these respiratory disorders. Objectives -To determine the prevalence of GERD in patients with respiratory disorders and lung involvement; the sensitivity of symptoms in the diagnosis of GERD; and the role of esophageal function tests (manometry and 24-hour pH monitoring) in the diagnosis and treatment of these patients. Methods -Prospective study based on a database of 44 patients (29 females) with respiratory disorders: 16 patients had idiopathic pulmonary fibrosis, 11 patients had systemic sclerosis associated interstitial lung disease, 2 patients had polymyositis associated interstitial lung disease, 2 patients had Sjögren associated interstitial lung disease, 2 patients had rheumatoid artrithis associated interstitial lung disease, 1 patient had undifferentiated connective tissue diseases associated interstitial lung disease and 10 patients had sarcoidosis. The average forced vital capacity (% predicted) was 64.3%. All patients had esophageal function tests. Results -Thirty patients (68%) had pathologic reflux (average DeMeester score: 45, normal <14.7). The average number of reflux episodes recorded 20 cm above the lower esophageal sphincter was 24. Sensitivity and specificity of heartburn were 70% and 57%, of regurgitation 43% and 57%, and of dysphagia 33% and 64%. Twelve patients with GERD underwent a laparoscopic fundoplication which was tailored to the manometric profile: three patients in which peristalsis was normal had a total fundoplication (360°) and nine patients in which the peristalsis was absent had a partial anterior fundoplication (180°). Conclusions -The results of our study show that: (a) abnormal reflux was present in about 2/3 of patients with respiratory disorders (idiophatic pulmonary fibrosis, connective tissue disorders and sarcoidosis), and it extended to the upper esophagus in most patients; (b) the sensitivity and specificity of reflux symptoms was very low; and (c) esophageal function tests were essential to establish the diagnosis of abnormal reflux, to characterize the esophageal function and guide therapy. Long term follow-up will be necessary to determine if control of reflux alters the natural history of these respiratory disorders.

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Section: Does Impairment In the Esophageal Motility Have Influence Onmentioning

confidence: 99%

Section: Is Surgical Treatment Effective and Does It Alter The Naturamentioning

confidence: 99%

Interstitial lung disease and gastroesophageal reflux disease: key role of esophageal function tests in the diagnosis and treatment

Soares

Forsythe

Hogarth

et al. 2011

Arq. Gastroenterol.

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“…The prevalence defined by maximal diameter (Dmax) was consistently higher than carinal diameter (Dcar), indicating maximal diameter is more sensitive but less specific criteria for esophageal dilation. Accumulating evidence suggests an important role of esophageal dysfunction in the development of lung disease in systemic sclerosis or other lung diseases (el-Serag and Sonnenberg 1997;Tobin et al 1998;Marie et al 2001;Savarino et al 2009;Christmann et al 2010;Patiwetwitoon et al 2012). In this study, we found a correlation between esophageal parameters and pulmonary function tests in systemic sclerosis patients.…”

Section: Discussionmentioning

confidence: 99%

“…It has been suggested that esophageal dysfunction and aspiration may play a role in pathogenesis of interstitial lung disease in systemic sclerosis and other lung diseases (el-Serag and Sonnenberg 1997; Tobin et al 1998;Marie et al 2001;Savarino et al 2009;Christmann et al 2010). Esophageal dilation on CT scan correlates well with esophageal dysfunction (Pitrez et al 2006;Vonk et al 2008).…”

Section: Introductionmentioning

confidence: 99%

Computed Tomography of the Esophagus in Scleroderma and Lung Disease

Takekoshi

Arami

Sheppard

et al. 2015

Tohoku J. Exp. Med.

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“…D'altro canto autorevoli lavori di comparazione hanno sottolineato la buona correlazione tra i dati scintigrafici e quelli forniti dalla cineradiografia con pasto baritato e dalla manometria, con una lieve maggiore sensibilità a vantaggio di quest'ultima metodica, peraltro mal tollerata dai pazienti (18,19). Il nostro studio conferma che l'impegno esofageo è uno dei più frequenti nella SSc, secondo anche nella nostra esperienza solo a quello polmonare (20); a tale riguardo è stato di recente suggerito che il reflusso gastro-esofageo potrebbe favorire la progressione dell'interstiziopatia polmonare (21). La compromissione della peristalsi mostrava nella nostra casistica la distribuzione caratteristica della SSc, coinvolgendo il terzo inferiore del viscere in quasi tutti i pazienti e quello medio in circa la metà, risparmiando invece il tratto superiore.…”

Section: Discussioneunclassified

Esophageal dysmotility in scleroderma patients with different disease forms and ANA patterns: a scintigraphic study in 100 cases

Cozzi¹,

Zucchetta²,

Durigon³

et al. 2011

Reumatismo

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La sclerosi sistemica (SSc) è una connettivite caratterizzata dall'elevata prevalenza di impegni viscerali. Tra essi uno dei più comuni è quello a carico dell'esofago, la cui frequenza è stata descritta come vicina a quella dell'interstiziopatia polmonare e superiore a quelle degli impegni cardiaco e renale (1, 2). Il danno anatomo-patologico provocato dalla SSc è simile in tutte le porzioni del tubo digerente: il bersaglio principale delle lesioni istologiche è rappresentato dalla tonaca muscolare, soprattutto nella sua componente circolare. In uno studio autoptico condotto su 46 pazienti affetti da SSc, nella cui storia clinica c'era una prevalenza di disfagia del 65%, le alterazioni istologiche riscontrate furono atrofia e/o fibrosi della tonaca muscolare liscia nel 74% dei casi, con localizzazione elettiva nei 2/3 inferiori del viscere, esofagite e ulcerazioni della mucosa nel 40% dei casi (3). Alla patogenesi delle lesioni si ritiene concorrano alterazioni della vascolarizzazione a carico delle arteriole, con ispessimento concentrico dell'intima, rigonfiamento delle cellule endoteliali e conseguente irregolarità del lume vasale, ed alterazioni del sistema nervoso autonomico, vista la sregolazione neurovegetativa ampiamente descritta nella SSc (4-7). Tappa finale del processo è l'attivazione dei fibroblasti con deposito di collagene sia nella parete vasale sia nella tonaca muscolare del viscere (8). La lesione iniziale è la compromissione dello sfintere esofageo inferiore, con conseguente reflusso Alterazioni della peristalsi esofagea nelle diverse forme cliniche e specificita' anticorpali della sclerodermia: studio scintigrafico in 100 pazienti

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Esophageal involvement and pulmonary manifestations in systemic sclerosis

Cited by 195 publications

References 59 publications

Interstitial lung disease and gastroesophageal reflux disease: key role of esophageal function tests in the diagnosis and treatment

Interstitial lung disease and gastroesophageal reflux disease: key role of esophageal function tests in the diagnosis and treatment

Computed Tomography of the Esophagus in Scleroderma and Lung Disease

Esophageal dysmotility in scleroderma patients with different disease forms and ANA patterns: a scintigraphic study in 100 cases

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