Manometric analysis of patients with gastrointestinal manifestations of scleroderma

Abstract

Purpose: The aim of this study was to analyze esophageal, anorectal and small bowel manometry studies in patients with scleroderma to determine whether GI symptoms correlate with manometric findings, and to determine if the findings of one GI manometric study predict the findings of another. Methods: Esophageal, duodenal and anorectal manometry studies from 32 scleroderma patients with GI symptoms were evaluated. Symptoms were recorded at the time of initial evaluation. Esophageal manometry (EMS) parameters included: LES pressure, percent LES relaxation, and amplitude of esophageal body contractions. Anorectal manometry (ARM) parameters analyzed included: Anal canal pressures, presence of rectoanal inhibitory reflex, external anal sphincter tone, and rectosigmoid compliance. Antroduodenal manometry was reviewed to assess neuromuscular function of the stomach and small intestine in response to drug challenges. Upper endoscopy and gastric emptying scans were reviewed, if available. Results: Mean age was 52.8 years (range 30 –77 years) with 27F:3M. Symptoms included: GERD in 31/32, dysphagia in 25/32, severe nausea/vomiting in 25/32, abdominal pain in 29/32 patients, abdominal bloating and distention in 25/32 patients, constipation in 16/32, and fecal incontinence in 14/32 patients. Mean LES pressure was 14.7 mm Hg; LES relaxation with water was complete in 10 patients and incomplete in 10. At 5 cm above LES, mean amplitude of contraction was 24.9 mm Hg. Anorectal manometry in 12 patients showed mean anal canal pressure of 31.4 mm Hg, relative EAS squeeze pressure of 40.4 mm Hg, average compliance of 3.62 ml/mm Hg and RAIR present in 6/12 patients. Small bowel motility in 5 patients demonstrated a reduced amplitude of contraction in the small intestine in 3 patients (normal in 2 patients). In 10 patients who underwent both EMS and ARM, low esophageal body contractile amplitudes were associated with low anal canal pressures. Conclusions: Symptoms of dysphagia and GERD were associated with low amplitude of contractions in the esophageal body, and fecal incontinence was associated with low anal canal pressures. Patients who had reduced esophageal body amplitudes were also likely to have reduced anal canal pressures. EMS findings did not correlate with small bowel manometric findings. Thus in scleroderma patients with complaints of both dysphagia and incontinence, the finding of low smooth muscle tone in the esophagus is likely to predict low anal canal pressures.