Oesophageal Motility and Lower Oesophageal Sphincter Competence in Progressive Systemic Sclerosis and Localized Scleroderma

Zaninotto, Giovanni; Peserico, Andrea; Costantini, Mario; Salvador, Laura; Rondinone, R; Roveran, Antonietta; Piasentin, G.; Glorioso, S; Merigliano, Stefano; Ancona, Ermanno; Peracchia, A.

doi:10.3109/00365528909092245

Cited by 32 publications

(14 citation statements)

References 10 publications

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“…76 In contrast to these studies, esophageal dysmotility was shown not to correlate with these antibodies in another study. 52 Compared with limited disease, diffuse PSS is associated with greater abnormalities on scintigraphy, 64,72 manometry, 51,59,71 pH studies, 59 and endoscopy. 51 However, other investigators reported no differences in the esophageal abnormalities in diffuse versus limited PSS.…”

Section: Esophageal Dysfunction In Disease Subsetsmentioning

confidence: 99%

“…It is abnormal in 54% to 86% of patients with PSS. 45,46,51,[57][58][59] Compared with non-PSS patients with similar degrees of esophagitis, the PSS patients had fewer reflux events but they were of significantly longer duration. 60 Aperistalsis correlated with increased numbers of distal reflux episodes with long duration, 22,45,46,61 although one study found that aperistalsis correlated with proximal rather than distal reflux.…”

Section: Diagnosis Of Esophageal Dysfunctionmentioning

confidence: 99%

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Esophageal Disease in Scleroderma

Ebert

2006

Journal of Clinical Gastroenterology

153

100

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Progressive systemic sclerosis (PSS) causes smooth muscle atrophy and fibrosis of the distal two-thirds of the esophagus. Motility studies show reduced-amplitude or absent peristaltic contractions in this region and normal or decreased lower esophageal sphincter pressure. Patients complain of dysphagia, heartburn, and regurgitation due to reflux and dysmotility. Complications include strictures found in 17% to 29% of patients and Barrett esophagus is 0% to 37%. Candida esophagitis is a complication of PSS not seen with non-PSS reflux. Esophageal disease correlates with pulmonary involvement but not with disease in the stomach or intestines. Whether reflux contributes to the pulmonary disease is an open question. Although manometry is the gold standard for diagnosis, cine-esophagram and scintography are only slightly less sensitive and should be considered for following the patients. Symptoms correlate poorly with evidence of esophagitis or abnormal 24-hour pH recordings. As a result, it is unclear which patients should receive acid-reducing or prokinetic medications and which medication to use. Aspiration precautions are important in those with severe esophageal dysmotility. This review of the literature highlights many areas of uncertainty in the diagnosis and treatment of esophageal disease in PSS that can be addressed in clinical studies.

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Section: Esophageal Dysfunction In Disease Subsetsmentioning

confidence: 99%

Section: Diagnosis Of Esophageal Dysfunctionmentioning

confidence: 99%

Esophageal Disease in Scleroderma

Ebert

2006

Journal of Clinical Gastroenterology

153

100

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“…Esophageal involvement is the best known and most frequent gastrointestinal manifestation of systemic sclerosis (SSc) and occurs in 50-80% of patients [1][2][3]. Pathophysiologically, the primary event appears to be an abnormality in cholinergic neural function, which is followed by smooth muscle atrophy and fibrosis [4,5].…”

Section: Introductionmentioning

confidence: 99%

Esophageal manometry in systemic sclerosis: screening procedure or confined to symptomatic patients?

Lock

Zeuner

Straub

et al. 1997

Rheumatology International

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The predictive value of esophagus-related symptoms for the diagnosis of esophageal dysmotility induced by systemic sclerosis (SSc) was prospectively evaluated in 50 consecutive patients with SSc. Patients were classified as symptomatic when either dysphagia or repeated episodes of heartburn were present. All patients underwent esophageal manometry; SSc-induced esophageal dysfunction was diagnosed when there was aperistalsis or marked hypocontractility of the distal two-thirds of the esophageal body. Twenty-nine patients (58%) had a history of esophagus-related symptoms, while 21 patients (42%) were asymptomatic. Compared to esophageal manometry, esophagus-related symptoms had a sensitivity of 64%, a specificity of 52%, a negative predictive value of 50% and a positive predictive value of 62% for the diagnosis of SSc-induced esophageal dysfunction. In conclusion, the association of esophagus-related symptoms and esophageal motility pattern is poor. As clinical management strategies depend on proof of esophageal dysfunction, screening examinations are mandatory in all patients with SSc.

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“…The prevalence of SSc-induced gastrointestinal involvement seems to decline from the cranial to the caudal end of the gastrointestinal tract, with the oesophagus being affected in 60-80% [3][4][5] of cases, stomach and small intestine in 40-60% [3,6], the colon in 10-50% ] 7,8], and the anorectum probably only in sporadic cases [9]. In two cases reports, slceroderma has been reported to be associated with a thickened and fibrosed gallbladder wall [10] or gallbladder vasculitis [1 1].…”

Section: Introductionmentioning

confidence: 99%

Gallbladder motility in systemic sclerosis

et al. 1996

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In 20 patients with systemic sclerosis (SSc) and 24 healthy controls, gallbladder motility was evaluated by abdominal ultrasonography after stimulation by a standard liquid meal. Results from patients with normal and disturbed oesophageal function were analysed separately in order to investigate the significance of gallbladder motility as a parameter for gastrointestinal involvement in SSc. All patients showed a marked decrease in gallbladder size after stimulation (patients 61 +/- 13%; controls 48 +/- 12%). Patients with oesophageal dysfunction (n = 12) had a slightly lower gallbladder contraction (maximal decrease = 58 +/- 13%) when compared to patients with normal oesophageal function (n = 8; 66 +/- 13%); however, this difference was not statistically significant. Gallbladder motility in patients with SSc was not reduced when compared with healthy controls. SSc-induced oesophageal dysfunction was not associated with impaired gallbladder motility. Thus, measurement of gallbladder emptying is not a helpful tool when looking for gastrointestinal involvement in SSc.

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Oesophageal Motility and Lower Oesophageal Sphincter Competence in Progressive Systemic Sclerosis and Localized Scleroderma

Cited by 32 publications

References 10 publications

Esophageal Disease in Scleroderma

Esophageal Disease in Scleroderma

Esophageal manometry in systemic sclerosis: screening procedure or confined to symptomatic patients?

Gallbladder motility in systemic sclerosis

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