Esophageal dysmotility in systemic sclerosis: Relationship with extra-gastrointestinal manifestations and complementary utility of thoracic imaging

Abstract

Introduction:

The relationship between manometric changes and esophageal dilation on chest high-resolution computed tomography is well established in systemic sclerosis, but its association with extra-esophageal manifestations is inconsistent. This study aims to characterize manometric findings in systemic sclerosis patients and to determine potential associations with esophageal body dysmotility.

Methods:

Retrospective single-center study including adult systemic sclerosis patients who underwent conventional or high-resolution esophageal manometry. Demographic and clinical data were collected. Associations between esophageal motility and disease duration, immunologic profile, cutaneous and pulmonary involvement, as well as endoscopic or tomographic esophageal alterations were evaluated.

Results:

A total of 76 patients were included. Conventional manometry was performed in 60 (78.9%), with aperistalsis observed in 23 (38.3%) and a normotonic lower esophageal sphincter in 45 (75.0%). Sixteen patients (21.1%) underwent high-resolution esophageal manometry, showing normal motility in 9 (56.3%), normotonic lower esophageal sphincter in 9 (56.3%), and hypotonic lower esophageal sphincter in 7 (43.8%). Overall, 46 patients (60.5%) had esophageal body dysmotility and 54 (71.1%) had normotonic lower esophageal sphincter. Most patients (84.2%) had limited cutaneous disease. Median disease duration was 5 years (interquartile range = 11) with mean age 54.1 ± 12.4 years. Seventy-one patients (93.4%) were females. Potential associations with manometric esophageal involvement were compared between patients with normal motility and dysmotility. Esophageal dilation on chest high-resolution computed tomography was more frequent among those with dysmotility (p = 0.005). No significant differences were found regarding disease duration, immunologic profile, modified Rodnan skin score, esophagitis, Barrett’s esophagus, interstitial lung disease, forced vital capacity, or single-breath carbon monoxide diffusing capacity.

Discussion:

Esophageal involvement was frequent in our sample, although the lower esophageal sphincter was more commonly spared. An association between esophageal dysmotility and its dilation on chest high-resolution computed tomography was found, highlighting the utility of chest high-resolution computed tomography for identification of upper gastrointestinal involvement in systemic sclerosis. No association was found between manometric changes and extra-esophageal manifestations.