The Predictive Factors of Abnormal Esophageal Motility in Systemic Sclerosis Patients by High Resolution Manometry

Abstract
Background: Esophageal motility changes occur in about 80% of systemic sclerosis (SSc) patients with decreasing the motility of the lower two-thirds of the esophagus and lower esophageal sphincter (LES) pressure.
Aim of Study: Using high resolution manometry (HRM) to study the esophageal motility disorder in patients with systemic sclerosis to evaluate the predictive factors associated with esophageal affection.
Patients and Methods: A prospective study was done on twenty female patients with SSc. Demographic data and esophageal symptoms including Gastroesophageal Reflux disease (GERD) and dysphagia were evaluated. All patients underwent HRM and High Resolution Computed Tomography (HRCT), Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Hemoglobin level (Hgb), Forced Vital Capacity (FVC).
Results: High resolution manometry showed normal upper esophageal contraction in 100% of patients. Middle and lower esophageal contraction were normal in 30%, hypoperestalsis in 5%, and aperestalsis in 65% of patients. Regarding the lower esophageal sphincter pressure, it showed normal pressure in 30%, hypotensive in 65% and hypertensive in 5% of patients. The esophageal involvement was GERD in 70% and dysphagia in 45% of patients. The pulmonary involvement was dyspnea in 70% and cough in 40% of patients. All patients had skin involvement. Abnormal motility was present in 14 out of 20 patients (70%) which was significantly related to Interstitial Lung Disease (SSc-ILD) (p= 0.001), SSc subtypes (p=0.03), dyspnea (p=0.01) and FVC (p=0.046). A significant relation between GERD and ILD (p<0.05) was found.
Conclusion: This study confirmed an increased prevalence of esophageal motility disorders in SSc patients with and without esophageal symptoms.