Abnormal postcibal antral and small bowel motility due to neuropathy or myopathy in systemic sclerosis

Abstract

Two hypotheses were tested: first, that postcibal motility disorders occur in both the antrum and small bowel of systemic sclerosis patients with gastrointestinal symptoms; second, that dysmotility may result from a neuropathic stage in this disease. Upper gut perfusion manometry (3 h fasting, 2 h fed) was performed and compared with data from similarly studied healthy laboratory controls (n = 15). Only 1 of 8 scleroderma patients had an interdigestive motor complex during the 3-h fasting period [0.1 ± 0.1 (SEM) for systemic sclerosis vs. 1.4 ± 0.16 (SEM) for controls, p < 0.05]; 2 other patients had fasting duodenal incoordinated bursts of phasic pressure activity in the duodenum or proximal jejunum. Distal antral motility index [MI = In (sum of amplitude × number of contractions + 1)] was lower (12.4 ± 0.5, p < 0.01) than that in controls (14.4 ± 0.14); both the amplitude and frequency of antral pressure activity were lower (p < 0.05) in systemic sclerosis. The intestinal fed pattern was characterized by reduced amplitude and frequency of contractions in 6 patients; 2 patients had excessive phasic or tonic small bowel pressure activity, or both. Thus, antral hypomotility is present in most symptomatic scleroderma patients; proximal small bowel postcibal motility is characteristically reduced; a minority of such patients have incoordinated fasting or postcibal hypermotility suggestive of a neuropathy. Manometry identifies the type and region of dysmotility in systemic sclerosis; our results suggest that there are neuropathic and myopathic stages of the upper gut involvement in systemic sclerosis.