Prolonged clearance is the primary abnormal reflux parameter in patients with progressive systemic sclerosis and esophagitis

Abstract

The purpose of this study is to determine if frequent reflux events from an incompetent LES or poor clearance from decreased peristalsis is the predominant abnormality in PSS patients with severe reflux esophagitis. Seven patients with both classic manometric findings of PSS and endoscopic findings of esophageal ulcerations and/or Barrett's esophagus were compared to nine patients with similar endoscopic findings but with no evidence of a connective tissue disorder. All patients underwent simultaneous intraesophageal pH monitoring and scintigraphy for a total of 40 min after a radiolabeled meal. Four of the PSS patients and all the non-PSS patients had simultaneous manometry. We found that PSS patients had significantly fewer reflux events (P less than 0.01), but the reflux events had significantly longer duration (P less than 0.01) compared to patients with similar severity of esophagitis and no connective tissue disease. We conclude that decreased smooth muscle peristalsis appears to be the primary contributor to acid exposure and esophageal injury in PSS.

The Spectrum of Motor Function Abnormalities in Gastroesophageal Reflux Disease and Barrett’s Esophagus

“…Barrett’s esophagus has been associated with other motility disorders of the gastrointestinal tract, namely scleroderma [132,133,134] and celiac disease. Severity and extent of reflux has been attributed to the integrity of distal esophageal peristalsis.…”

“…Severity and extent of reflux has been attributed to the integrity of distal esophageal peristalsis. Murphy et al [133] found a significantly lower number of reflux events, but they were of longer duration when patients with manometric features of scleroderma and endoscopic findings of esophageal ulcerations and/or Barrett’s esophagus were compared to patients with similar endoscopic findings but without an associated connective tissue disorder. Based on their findings, they concluded that decreased smooth muscle peristalsis was attributed to be the primary contributor of esophageal injury in scleroderma.…”

Gastrointestinal motility disorders in scleroderma

“…To evaluate the relative importance of these two factors, a recent report employed simultaneous manometry, esophageal pH monitoring, and esophageal scintigraphy to study SSc and non-SSc patients with severe gastroesophageal reflux (36). The SSc group had significantly fewer reflux events than did the non-SSc reflux group (although more than normal controls), but once acid was refluxed, it took substantially longer to clear from the esophagus.…”

A Case of Chronic Intestinal Pseudo-Obstruction

“…Gastroesophageal reflux disease (GERD) is the most significant clinical condition. GERD occurs as a result of both the decreased LES resting pressure, which allows an increased number of reflux events, and poor peristalsis, which delays acid clearance 16,17 . The complications of longstanding GERD include candida esophagitis, erosive esophagitis, esophageal stricture, Barret's esophagus, and aspiration.…”