The diagnostic value of oesophageal transit scintigraphy for evaluating the severity of oesophageal complications in systemic sclerosis.

Abstract

Oesophageal complications are common in systemic sclerosis (SSc). However, the ability to determine the severity of oesophageal complications according to SSc type and skin lesion has not been evaluated. The study groups consisted of 35 patients with SSc who were classified into diffuse (n=20) and limited (n=15) cutaneous types, and 16 control subjects. An additional 26 consecutive patients were studied for an analysis of the reproducibility. The severity of a skin lesion was quantified by using a modification of Rodnan's total skin thickness scores. Oesophageal scans were performed after the subjects, in sitting and supine positions, had consumed potage soup. Condensed images of the dynamic study were classified into four patterns: normal, transient retention, slight retention and severe retention, in conjunction with parameters of retention fraction by analysing the time-activity curve. The highest reproducibility was obtained using retention at 90 s (R90, r=0.93). Analysis of the condensed images showed that the SSc patients had a higher incidence of severe retention than did the control subjects. Groups with diffuse-type SSc or a high skin thickness score showed a higher incidence of severe retention (P=0.041 and 0.0048, respectively) compared with the control and less severe groups. The R90 in the supine position differed significantly among the controls, the limited-type and diffuse-type SSc groups (mean+/-SEM, 10+/-1%, 24+/-5%, 38+/-6%, respectively; P=0.0004)). The group with high skin scores (i.e. > or =10) showed a higher R90 (41+/-6%) than did either the group with low skin scores (R90=23+/-5%) or the control group (P=0.0001). An oesophageal scan can detect both slight and severe types of oesophageal dysfunction, and can be used as a quantitative method that reflects functional abnormality in SSc.