Gastrointestinal motility disorder assessment in systemic sclerosis

Giacchino

Current Opinion in Otolaryngology & Head and Neck Surgery

2013

Section: Causementioning

confidence: 99%

Dysmotility and reflux disease

Giacchino

Current Opinion in Otolaryngology & Head and Neck Surgery

2013

“…1 The oesophagus is involved with a prevalence of 50-90% with a replacement of smooth muscle by collagenous fibrosis and smooth muscle atrophy leading to motor activity abnormalities. 2 The distal two-thirds and the lower oesophageal sphincter (LOS), composed of visceral smooth muscles, are the main target of SSc 3 4 with a decreased pressure or total LOS incompetence, and distal oesophageal peristaltic waves abnormalities.…”

Section: Introductionmentioning

confidence: 99%

Evidence for oesophageal and anorectal involvement in very early systemic sclerosis (VEDOSS): report from a single VEDOSS/EUSTAR centre

et al. 2013

BackgroundThe oesophagus is the first gastrointestinal (GI) tract involved in systemic sclerosis (SSc), followed by the anorectum.ObjectiveEvaluation of oesophageal and anorectal involvement and their correlations in patients with very early diagnosis of SSc (VEDOSS).Patients and methods59 patients with VEDOSS, evaluated with oesophageal and anorectal manometry and investigated with lung function tests and chest HRCT. Demographic data, oesophageal and anorectal symptoms, Raynaud's phenomenon, autoantibodies, videocapillaroscopy patterns, puffy fingers and digital ulcers were recorded for all patients.ResultsIn 4 patients oesophageal manometry and in 17 patients anorectal manometry was not performed because of scarce tolerance. Oesophageal peristalsis was absent in 14 patients; its pressure and speed were significantly lower in 41 patients (p<0.001 and p=0.005, respectively). The maximum pressure and mean pressure (Pmax and Pm) of lower oesophageal sphincter were significantly lower (p=0.012 and p=0.024, respectively). Patients with a diffusing capacity of the lung for carbon monoxide<80% presented a hypotonic lower oesophageal sphincter (p=0.008) and an abnormal peristalsis (p<0.001); patients with a diffusing capacity of the lung for carbon monoxide>80% showed only an abnormal peristalsis (<0.001). The anal resting pressure (ARP) at 4.3 cm and 2 cm from anal edge and the anal canal Pm were significantly decreased (p<0.001 and p=0.010, respectively). The maximum voluntary contraction was significantly abnormal in its Pmax and Pm (p=0.017 and p=0.005) and in its duration (p=0.001). In patients with a positive HRCT, the ARP and the canal Pmax and Pm were significantly lower; patients with negative HRCT presented only an abnormal ARP.ConclusionsIn patients with VEDOSS, oesophageal and anorectal disorders are frequently detected, showing that very early SSc is characterised by GI involvement.

“…Many studies [4] in literature had evaluated the correlation between OCTT and gastric emptying with the development of lactose intolerance symptoms during a breath test [14,15]. It is well known, in fact, that gastric emptying rate and intestinal transit time alters the time in which lactose is exposed to intestinal lactase.…”

Section: Discussionmentioning

confidence: 99%

Early peak of hydrogen during lactose breath test predicts intestinal motility

Ojetti¹,

Rienzo²,

D’Angelo³

et al. 2014

OJGas

Lactose breath test (LBT) is considered the gold standard for the diagnosis of lactose malabsorption.The test is considered positive for a peak of hydrogen (H 2 ) ≥ 20 parts per million (ppm) above the baseline. Some patients (pts) showed a rapid peak between 30 and 90 minutes after lactose ingestion. The aim of this study was to evaluate the predictive value of an early peak during a LBT and an accelerated oro-cecal transit time (OCTT). We retrospectively analyzed all pts who referred to our Gastroenterology unit for Irritable Bowel Syndrome, from January to September 2012, who performed LBT, glucose and lactulose breath test. We consider a positive LBT for a peak of H 2 > 20 ppm, a positive GHBT for a peak >12 ppm and we considered a normal OCCT a peak of H 2 ≥ 10 ppm between 75 ± 105 min after lactulose load. The correlation between LBT and OCTT was evaluated by Pearson score. 93 pts (65 F/28 M mean age 47 ± 6 years) with a positive LBT, without small intestinal bacterial overgrowth were analyzed: 46 pts (32 F/14 M; mean age 48 ± 6 years) with an early peak (<90 min) of H 2 (≥20 ppm) were enrolled as case, and 47 pts matched for sex and age with a peak of H 2 after 90 min were enrolled as controls. 72% (33/46) of the group with an early peak showed an accelerated, 17% (8/46) a normal and 11% (5/46) a delayed OCTT. Meanwhile, in control group 40.4% (19/47) showed a normal, 57.5% (27/47) a delayed and just 1 pts an accelerated OCTT. The specificity and sensibility of LBT for an accelerated OCTT were 97.9% and 71.7% respectively. The positive predictive value of LBT for an accelerated OCTT is 97.1%; the negative predictive value is 78%. There is a significant correlation between LBT and OCTT (p < 0.05). The presence of an early peak of H 2 between 30 and 90 min after the ingestion of 25 gr of lactose could predict the presence of an accelerated OCTT in 97% of pts. If confirmed by further study, in this subset of pts, lactulose breath test for evaluating OCTT could be avoided.