Spectrum of GastroEsophageal Reflux Disease (GERD) in Systemic Sclerosis (SSc)-Associated Esophageal Dysmotility as Defined by High Resolution Esophageal Manometry (HREM)

Abstract

Introduction: The worsening esophageal dysmotility and incompetent lower esophageal sphincter(LES) are major contributors of GERD in patients with SSc. The spectrum of GERD can vary from nonerosive disease to severe esophagitis with stricturing. Our aim was to see if degree of esophageal dysmotility as defined by HREM correlated with the severity of GERD in SSc patients. Methods: This is a retrospective chart review of all SSc patients who underwent HREM at our institution from January 2008 to October 2014. The following data were collected: demographic features (age, gender, and race), medications, tobacco and alcohol use, esophagogastroduodenoscopy(EGD) findings, pH studies, and barium esophagogram results. All HREM were reinterpreted using the Chicago Classification of Esophageal Motility Disorders, v3.0 criteria. Data are reported as mean ± standard deviation, median, or frequency (percent). For univariate analyses, we used analysis of variance(ANOVA), non-parametric Kurksal-Wallis, Pearson's chi-square, or Fisher's Exact tests, where appropriate. Results: A total of 122 patients with SSc underwent HREM of which 73 had absent contractility(AC), 22 had ineffective esophageal motility(IEM), and 23 had a normal study. On upper endoscopy, erosive esophagitis, hiatal hernia and esophageal strictures were more common in AC than in other two groups. There were no statistically significant differences in other endoscopic findings in all three groups (Table 1). On barium esophagogram, esophageal dysmotility and dilated esophageal lumen were more prevalent in AC group. Of note, 6 out of 78 patients had barium esophagograms suggestive of achalasia but HREM showed AC with low LES pressure. Conversely, one patient had Type II Achalasia on HREM but the barium esophagogram showed normal primary peristalsis with retrograde escape and impediment to passage of 13 mm barium tablet at gastroesophageal junction. Esophageal pH testing showed no association with severity of esophageal dysmotility.Table 1: Esophageal Testing in SSc hiaConclusion: In this large cohort of SSc patients who underwent HREM, the severity of GERD related endoscopic and barium esophagogram findings correlated with the degree of esophageal dysmotility. However, a similar association was not observed between esophageal dsymotility and pH study results in patients with SSc.