Oesophageal pressure–cross‐sectional area distributions and secondary peristalsis in relation to subclassification of systemic sclerosis

Abstract

The aim of the present study was to correlate the severity of oesophageal motor dysfunction with the severity of cutaneous disease in systemic sclerosis (SS). Patients were divided into three groups based on the degree of skin involvement: type I, acrosclerosis distal to the wrist; type II, scleroderma extending above the wrist in proximal direction; type III, diffuse cutaneous systemic sclerosis. Impedance planimetry employing distensions with pressures up to 5 kPa with the concomitant measurement of oesophageal cross-sectional area (CSA) was used in combination with standard oesophageal manometry. Measurements were made at 7 and 15 cm above the lower oesophageal sphincter (LOS). Thirty patients (16 type I, six type II and eight type III patients) and 23 normal controls were included. LOS pressure was lower in SS patients than in normal patients, with the lowest values in type III. The CSAs were higher in SS patients than in controls at both sites (P < 0.001). The CSAs at the distal site were highest in type III, as compared to type I and II (P < 0.03). The CSA at the highest induced pressure (5.0 kPa) was 613 +/- 45, 719 +/- 79, and 808 +/- 115 mm2 in types I, II and III, respectively. No differences in CSA were found at the proximal site between the three types of SS. The distensibility did not differ between SS and normal patients at the distal site. The distensibility was lowest in SS patients (P < 0.001) at the proximal distension site. The distensibility did not vary with the type of SS at either site. Significant differences in contraction frequency of the secondary peristalsis as function of wall tension were demonstrated between the SS patients and controls at the distal site (P < 0.05). No differences were found at the proximal site. The contraction frequency and amplitude at the distal and proximal sites did not differ among the three types. In conclusion for most parameters studied, SS patients differed from normal patients. Among SS types, the most pronounced changes were found in type III.

Deterioration of Muscle Function in the Human Esophagus with Age

“…The interested reader is referred to those and other publications for methodological and analytical considerations and interpretation of the in vivo muscle function curves [10,13,15,[18][19][20][21][22][23][24][25]. Corresponding analysis on length-tension relations in muscle strips in vitro has been described in other papers [26,27].…”

Mechanical Characteristics of Distension-Evoked Peristaltic Contractions in the Esophagus of Systemic Sclerosis Patients

“…The patients and volunteers in this study, including demographic and clinical data, have been described in detail by Villadsen and coworkers [9]. In brief, eleven patients (8 women and 3 men, average age 51.2 ± 9.2 (range 33-71) years) suffering from SS and abnormal esophageal motility were included in the study.…”

“…Thus, measurements are obtained at one specific locus. Furthermore, CSA is more closely associated with the diametrical changes in the esophageal lumen than volume is [9][10][11]. Previous mechanical studies of SS patients using impedance planimetry have shown esophageal and duodenal dilatation, wall stiffening, and reduced muscle contractility [9][10][11][12][13].…”

“…The contraction frequency and the amplitude of pressure recordings are commonly used to characterize GI motility [9,10,14]. Only sparse data have been obtained from GI studies on single contraction cycle analysis.…”

Beneficial effect of the 5‐HT1A receptor agonist buspirone on esophageal dysfunction associated with systemic sclerosis: A pilot study

“…Esophagus is the most commonly affected organ, occurring in up to 90% of patients with SSc. [1][2][3] Clinically it is characterized by symptoms of gastroesophageal reflux disease (GERD) and of esophageal motor dysfunction. Typical symptoms of heartburn and dysphagia are reported by 80% of patients.…”