High Resolution Esophageal Manometric (HREM) Findings in Patients With Systemic Sclerosis

Abstract

Introduction: Esophageal dysmotility is reported in up to 96% patients with SSc. The classic manometric finding is absence of peristalsis in the distal two-thirds of smooth muscle of the esophagus with low lower esophageal sphincter (LES) pressure. With earlier detection of esophageal involvement, different manometric abnormalities are seen on HREM. Our aim was to characterize esophageal motility disturbances in patients with SSc using HREM. Methods: Patients with SSc who underwent HREM between January 2008 and October 2014 at our institution were identified. All HREM studies were reinterpreted using the Chicago Classification of Esophageal Motility Disorders, v3.0 criteria. We also reviewed patients' age, gender, race, tobacco and alcohol use, as well as medications. Data are presented as mean ± standard deviation, median or frequency (percent). For all univariate analyses, analysis of variance (ANOVA), non-parametric Kurksal-Wallis, Pearson's chi-square, Fisher's Exact tests were used when appropriate. Results: 122 patients underwent HREM during the study period of which 92 were women and 30 were men. The mean age was 54.2 ± 13.6 years. The HREM diagnoses were normal in 23, ineffective esophageal motility (IEM) in 22, absent contractility (AC) in 73 and one case each of Type II Achalasia, EGJ outflow obstruction, hypercontractile esophagus, and distal esophageal spasm. The mean basal LES pressure was 17.1mm Hg [8.1, 27.0] and the mean IRP was 3.4 mm Hg[1.2, 6.3]. We compared the demographic, clinical and manometric data between patients with normal contractility, IEM and AC. Patients with AC were younger than other two groups (Table 1). There is higher prevalence of antidepressant use in patients with normal HREM and higher prevalence of pulmonary hypertension in IEM patients. The basal meanLES pressure was lowest in AC (Table 2). There was no statistically significant difference in gender, race, tobacco, alcohol use and other medication use among the three groups of patients (Table 1).Table 1: Patient CharacteristicsTable 2: High Resolution Manometry FindingsConclusion: Diverse motility abnormalities were noted on HREM in SSc with over 78% of patients having IEM or AC. Patients with AC were younger than other groups suggestive of an early, aggressive phenotype. Future prospective studies are needed to identify and intervene in patients before they develop severe esophageal dysfunction.