Esophageal transit scintigraphy and structured questionnaire in patients with systemic sclerosis with endoscopically proven reflux esophagitis

Abstract

Objectives: Esophageal complication is common in patients with systemic sclerosis (SSc). The relationship between gastroesophageal reflux (GER) symptoms and dysmotility was examined in endoscopically confirmed patients with suspected of having reflux esophagitis. Methods: A total of 32 patients with limited and diffuse type SSc (lSSc, dSSc) were examined based on a structured questionnaire score (QS) of GER symptoms, retention fraction of esophageal scintigraphy at 90 seconds (R90) and gastric emptying time. Results: The QS was significantly higher in the reflux esophagitis group than in the nonesophagitis group (5.4 ± 3.5, 1.4 ± 2.9, p=0.003). When the non-esophagitis group was further divided into lSSc and dSSc groups, R90 was higher in the reflux esophagitis group (31% ± 18%) and the non-esophagitis group with dSSc (34% ± 32%) than in the non-esophagitis group with lSSc (8% ± 3%, p=0.02). Both high R90≥15% and QS≥4 indicated reflux esophagitis. Conversely both normal R90 and QS indicated no reflux esophagitis. Conclusion: A combination of esophageal scintigraphy and structured questionnaire demonstrated different aspects of esophageal dysfunction, namely dysmotility and GER. Patients with high QS and dysmotility may be indicated for further evaluation including endoscopic examination and medical treatment.

Esophageal transit study using a sliding sum image: application to patients with probable and definite systemic sclerosis

“…In this study about half of the patients with definite SSc showed abnormal transit, which was less than that of the histological examination. Although GERD symptoms are considered to be common complications in SSc patients, we have found that some patients showed dysmotilitydominant symptoms rather than GERD symptoms using a questionnaire method [19]. It is conceivable that slight histological abnormality did not directly appear as a transit abnormality, and the dysmotility would become evident after certain stages.…”

“…An esophageal transit study was performed as described [11,19]. The study was performed under fasting condition for at least 6 hours, and current medications that may alter esophageal transit were documented.…”

“…A large-field of view rectangular camera was used and equipped with a low-energy high-resolution collimator (e.cam, Siemens, Tokyo, Japan). To evaluate the GERD symptoms, a structured questionnaire to semiquantify the symptom was used [19]. A questionnaire score of ≥4 was considered significant as a reflux symptom.…”

Assessment of swallowing function with oro‐pharyngeal‐esophageal scintigraphy in patients with idiopathic inflammatory myopathies

“…OPES has been used since 1970 for the study of the swallowing function in patients with head and neck disease including patients with neuromuscular disorders. Several studies have suggested a higher sensibility of OPES compared to esophageal manometry and to barium swallow X‐ray …”

Gastroesophageal Reflux Disease-Related Disorders of Systemic Sclerosis Based on the Analysis of 66 Patients

“…Such high prevalence is probably due to abnormal motility characterized by the loss of peristalsis in distal esophagus and lower esophageal sphincter pressure [10,11]. On the other hand, it was reported that neither disease duration nor the type of SSc shows meaningful association with the presence of RE [12,13]. Despite these several previous reports, evidence showing an association between RE and background factors of SSc patients is still inadequate.…”