Radionuclide imaging for the assessment of esophageal motility disorders in mixed connective tissue disease patients: relation to pulmonary impairment

Abstract

Esophageal functional abnormalities may lead to regurgitation, chronic esophagitis and life-threatening conditions such as aspiration pneumonia. In mixed connective tissue disease patients, previous reports showed that esophageal dysfunction varies according to the method employed for investigation. Our study was conceived to: (i) assess esophageal motility and mucosal aspects in patients with mixed connective tissue disease by endoscopy, cine-esophogram and scintigraphy focusing on the prevalence of each exam; and (ii) verify the association between pulmonary and esophageal dysfunctions. Twenty-four mixed connective tissue disease patients were enrolled for this study. Cine-esophogram and upper digestive endoscopy with mucosal biopsy were performed according to previous standardization. Radionuclide esophageal scintigraphy was performed with a semisolid meal with (99m)Tc. Eleven healthy individuals voluntarily submitted to scintigraphy as controls. Cine-esophogram showed esophageal delayed emptying in 90% of patients. At scintigraphy there was a significant delay in total esophageal transit time in the group of patients when compared to healthy controls (35.3 +/- 8.2 s. vs. 13.6 +/- 9.5 s.; P < 0.0001). The whole esophageal body showed dysmotility in 96% of patients. The cine-esophogram detected functional esophageal impairment similar to scintigraphic findings. Histopathologic examination found esophagitis in 95% of studied patients. Reduced lung volumes were associated with esophagitis and delayed esophageal clearance at scintigraphy, observed at the distal portion of the esophagus. Esophageal scintigraphy is easy to perform, with good acceptance by patients with low radiation exposition. It is a useful non-invasive test for follow-up and interventional studies concerning esophagus dysfunction.

Systematic review: the relationship between interstitial lung diseases and gastro‐oesophageal reflux disease

“…Pulmonary dysfunction and oesophageal hypomotility are recognised manifestations of MCTD and may often be detected prior to the onset of symptoms. In the studies presented, a significant correlation was demonstrated between severe oesophageal motor dysfunction (on manometry or radionuclide imaging study) and the presence of ILD (as assessed by PFT, DLCO and HRCT) [Evidence B] 24, 25 . These findings suggest that ILD may be associated with regurgitation of food in patients with MCTD because it is more common in those with oesophageal dilatation on CT and with severe oesophageal dysfunction on manometry.…”

“…The relationship between gastro‐oesophageal reflux and interstitial lung disease in patients with MCTD was evaluated in two studies (Table 3) [Evidence B] 24, 25 . In one prospective small‐sample study, the presence of ILD was assessed by PFT and HRCT, while oesophageal abnormalities were assessed by manometry, 24‐h oesophageal pH monitoring and the presence of oesophageal dilation on CT scan 24 .…”

“…The second study retrospectively assessed the association between oesophageal dysmotility (as determined by cine‐video oesophagram and scintigraphy), oesophageal mucosal findings, and pulmonary function (using PFT and HRCT) in 24 patients with MCTD 25 . Heartburn was present in 37.5% and dysphagia to solids in 75% of patients.…”

Sensory and Instrumental Analysis for Slipperiness and Compliance of Food during Swallowing

“…Until now, videofluoroscopy (Palmer and others 1993; Buettner and others 2002; Saitoh and others 2007), ultrasonography (Furukawa and others 2003; de Wijk and others 2006), radionuclide imaging (Caleiro and others 2006; Bogaardt and others 2007), and fiberoptic endoscopy (Leder 1998; Leder and others 2005) have been typically used for monitoring swallowing. These assessments, however, have certain limitations in food science applications due to their high cost and need for medical training (Kohyama and others 2007).…”

Effects of anatomical position on esophageal transit time: A biomagnetic diagnostic technique

“…The ETT assessment is used to complete the diagnosis of diseases, such as gastroesophageal reflux [12][13][14] , dysphagia [15,16] , esophagitis [17,18] , and achalasia [6,19,20] . The latter studies are commonly performed with scintigraphic and manometric techniques [21] , in healthy [22] , geriatric [23] , and pediatric patients [24] , despite the use of ionizing radiation and catheters in each test, respectively. Recently, several assessments were performed using the biomagnetic technique, including gastric emptying time [25] and colon transit time [26] .…”