S473 High Prevalence of Esophageal Motility Disorders in Patients With Rheumatic Diseases

Abstract

Introduction: While esophageal motor dysfunction is known to be associated with systemic sclerosis, the prevalence of esophageal dysmotility in other rheumatic conditions is not well known. The aim of this study was to examine the prevalence of esophageal motility disorders in rheumatic diseases. Methods: In this retrospective cohort study, adults with a diagnosis of a rheumatic disease [rheumatoid arthritis (RA), Sjogren’s syndrome, systemic sclerosis (SS), systemic lupus erythematous (SLE), mixed connective tissue disease (MCTD), idiopathic Raynaud’s phenomenon, and other], who underwent high-resolution esophageal manometry (HREM) were included. Demographics, clinical characteristics, rheumatic diseases and associated therapies, HREM findings, motility disorders per Chicago classification (CCv3.0) criteria and swallow characteristics, were extracted from the medical record. We analyzed the data using descriptive statistics to assess the prevalence and types of esophageal motor disorders amongst patients with known rheumatic conditions. Results: Of 118 patients, 80% were women, and 73% were white (Table). The most common esophageal symptoms were dysphagia (88%), heartburn (81%), and regurgitation (41%). Rheumatic diseases included RA (38%), Raynaud’s (30%), Sjogren’s (22%), SS (19%) and MCTD (11%). On HREM, 53% had an esophageal motility disorder per Chicago classification. Of note, 38% of the sample with a normal barium swallow had an esophageal dysmotility disorder on HREM. Esophageal hypocontractility (including ineffective esophageal motility, absent contractility, and fragmented peristalsis) was diagnosed in 29 patients (25%), achalasia and/or esophagogastric junction outflow obstruction were found in 25 (21%), and esophageal hypercontractility (including diffuse esophageal spasm and jackhammer esophagus) in 8 (7%). These esophageal disorders were found amongst rheumatic diseases including SLE, RA, Sjogren’s, SS, MCTD, psoriatic arthritis and Raynaud’s (Figure). Conclusion: Esophageal motor disorders were found in more than half of patients with rheumatic diseases who underwent HREM, even though many patients previously had a normal barium swallow. HREM should be considered in patients with rheumatic conditions who present with esophageal symptoms.Figure 1.: Disorders of Esophageal Motility by Rheumatologic DiseaseTable 1.: Patient Characteristics and Manometry Findings