New developments in esophageal function testing and esophageal manifestations of connective tissue disorders

Abstract

This work summarizes new and emerging metrics and tools in esophageal function testing and their potential clinical impact. Because the diagnostic sensitivity and reliability of conventional impedance‐pH variables are suboptimal, several novel impedance parameters, such as the postreflux swallow–induced peristaltic wave index and the mean nocturnal baseline impedance, as well as mucosal impedance, are entering a validation stage prior to general clinical use. The accurate diagnosis of behavioral disorders in patients with rumination syndrome and supragastric belching using ambulatory multiple intraluminal impedance‐pH can lead directly to behavioral interventions in patients with refractory gastroesophageal reflux disease (GERD). New provocative measures, such as multiple rapid swallows and the rapid drink challenge, have been developed to overcome the limitations of standard high‐resolution esophageal manometry, aiming at further clarifying esophageal dysmotility. Furthermore, the current diagnostic and therapeutic challenges in patients with esophageal involvement in Sjogren's syndrome and scleroderma, who tend to have severe forms of GERD, are entering a new investigative and clinical phase.

Autoimmune Dysphagia Related to Rheumatologic Disorders: A Focused Review on Diagnosis and Treatment

“…Multiple mechanisms can be implicated, including xerostomia, neuropathy, cricoarytenoid joint arthritis, esophageal dysmotility, and gastroesophageal reflux [ 44 ]. Xerostomia, by interfering with the triggering of peristalsis, could result in delayed swallowing during the oral and pharyngoesophageal phases, decreased acid clearance in the esophagus, and increased symptoms of esophageal dysmotility [ 45 ]. Dysphagia may result from complications associated with xerostomia, such as opportunistic infections (Candida albicans), dental caries, and loss of teeth [ 41 ].…”

“…CT: computed tomography, MRI: magnetic resonance imaging, EGD: esophagogastroduodenoscopy References:[1,[45][46][47][48][49] …”

Possible causes of a focal esophageal muscle defect

“…A case‐control study showed that smooth‐muscle atrophy was found in 94% of patients with SSc compared with 5% of control subjects 3 . In addition, it is known that esophageal involvements at various frequencies are found in patients with other autoimmune connective tissue diseases (CTDs) 4,5 . Thus, the presence of CTDs should be examined, if an esophageal localized muscular defect is found.…”