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2008, Number 5

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Rev Med Inst Mex Seguro Soc 2008; 46 (5)

Clinical, Endoscopic and Manometric Findings in the Gastroesophageal 503 Tract of Patients with Systemic Sclerosis

Santos-Navarro RR, Méndez-del-Monte R, del Real-Calzada C, Vera-Lastra OL

Language: Spanish
References: 88
Page: 503-510
PDF size: 272.31 Kb.


ABSTRACT

Background: in the systemic sclerosis (SSc) gastrointestinal manifestations are present up to 90 % and the esophagus is the most affected organ. The purpose was to investigate clinical, endoscopic and manometric upper gastroesophageal manifestations in patients with SSc.
Methods: we studied 60 patients with SSc, mean age of 48 ± 11 years and a mean disease evolution of 11 ± 8 years. An endoscopy of gastro-esophageal tract and esophageal manometry were performed.
Results: the clinical manifestations were: dysphagia 80 %, pirosis and regurgitations 78 %. Endoscopic findings were: esophagitis 60 %, hiatal hernia 65 %, loose hiatus 15 % and Barrett’s esophagus 18 %. Manometric findings were hypotensive lower esophageal sphincter (LES) 95 %. Aperistalsis (41 %), slight hypomotility (30 %), severe hypomotility (27 %) were found. Gastric manifestations were: early satiety 45 %, abdominal pain 35 %, nausea 20 % and vomiting 10 %, and by endoscopy we observed: Gastric disturbances in 80 %, of these 40 % corresponds to non erosive gastropathy, 30 % to erosive gastropathy and 10 % to nodular gastropathy.
Conclusions: the most frequents endoscopic finding were esophagitis and hiatal hernia, and by manometry were aperistalsis and hypotensive LES. These alterations imply disorders of motility and dysfunction of LES. Barrett’s esophagus was always associated with hiatal hernia.


REFERENCES

  1. Vera-Lastra O. Esclerosis sistémica. Med Int Mex 2006;22:231-245.

  2. Rose S, Young MA, Reynolds JC. Gastrointestinal manifestations of scleroderma. Gastroenterol Clin North Am 1998;27:563-594.

  3. Young MA, Rose S, Reynolds JC. Gastrointestinal manifestations of scleroderma. Rheum Dis Clin North Am 1996;22:797-823.

  4. Sjögren RW. Gastrointestinal features of scleroderma. Curr Opin Rheumatol 1996;8:569-575.

  5. Goldblatt F, Gordon TP, Waterman SA. Antobodymediated gastrointestinal dysmotility in scleroderma. Gastroenterology 2002;123:1144-1150.

  6. Attar A. Digestive involvement of scleroderma. Ann Med Interne 2002;153:260-264.

  7. Sallam H, McNearney TA, Chen JD. Systematic review: pathophysiology and management of gastrointestinal dysmotility in systemic sclerosis (scleroderma). Aliment Pharmacol Ther 2006 15; 23:691- 712.

  8. Bassotti G, Battaglia E, Debernardi V, Germani U, Quiriconi F, Dughera L, et al. Esophageal dysfunction in scleroderma. Arthritis Rheum 1997; 40:2252-2259.

  9. Abu-Shakra M, Guillemin F, Lee P. Gastrointestinal manifestation of systemic sclerosis. Sem Arthritis Rheum 1994;24:29-39.

  10. Hamel-Roy J, Devroede G, Arhan P, Tetreault L, Duranceau A, Menard H. Comparative esophageal and anorectal motility in scleroderma. Gastroenterology 1985;88:1-7.

  11. Clements PJ. Systemic sclerosis (scleroderma) and related disorders: clinical aspect. Baillieres Clin Rheumatol 2000;14:1-16.

  12. Roberts CG, Hummers LK, Ravich WJ, Wigley FM, Hutchins GM. A case-controlled study of the pathology of oesophageal disease in systemic. Gut 2006;55:1697-1703.

  13. Vera-Lastra O. Esclerosis sistémica y tracto gastrointestinal. Abordaje diagnóstico y terapéutico. Reumatol Clin 2006;2:24-30.

  14. Misra R, Singh G, Aggarwal P, Aggarwal A. Juvenile onset systemic sclerosis: a single center experience of 23 cases from Asia. Clin Rheumatol 2007;26(8):1259-1262.

  15. Sharma VK, Trilokraj T, Khaitan BK, Krishna SM. Profile of systemic sclerosis in a tertiary care center in North India. Indian J Dermatol Venereol Leprol 2006;72:416-420.

  16. Dantas RO, Aprile LR. Esophageal striated muscle contractions in patients with gastroesophageal reflux symptoms. Dig Dis Sci 2002;47:2586-2590.

  17. Szigeti N, Fabian G, Gomori E, Czirjak L. Barrett esophagus in systemic sclerosis. Orv Hetil 2001; 142:671-674.

  18. Wipff J, Allanore Y, Soussi F, Terris B, Abitbol V, Raymond J, et al. Prevalence of Barrett’s esophagus in systemic sclerosis. Arthritis Rheum 2005;59: 2882-2888.

  19. Niv Y, Abu-Avid S, Yelin A, Liberman Y. Barrett’s ephithelium and esophageal adenocarcinoma in scleroderma. Am J Gastroenterol 1988;83:792-793.

  20. Heath EI, Limburg PJ, Hawk ET. Adenocarcinoma of the esophagus: risk factors and prevention. Oncology (Huntingt) 2000;14:507-514.

  21. Contreras MA, Salas C, Andreu JL, Mulero J. Cytomegalovirus esophagitis as a treatable complication of systemic sclerosis. J Clin Rheumatol 2001;7: 384-387.

  22. Marie I, Dominique S, Levesque H. Esophageal involvement and pulmonary manifestations in systemic sclerosis. Arthritis Rheum 2001; 45:346-354.

  23. Ing AJ. Interstitial lung disease and gastroesophageal reflux. Am J Med 2001;111(Suppl 8A):41S-44S.

  24. Al-Amri SM. The pattern of esophageal manometry in progressive systemic sclerosis. Saudi Med J 2003; 24:68-71.

  25. Marie I. Gastrointestinal involvement in systemic sclerosis. Press Med 2006;35:1952-1965.

  26. Ebert EC. Esophageal disease in scleroderma. J Clin Gastroenterol 2006;40:769-775.

  27. Pitrez EH, Bredemeier M, Xavier RM, Capobianco KG, Restelli VG, Vieira MV, et al. Oesophageal dysmotility in systemic sclerosis: comparison of HRCT and scintigraphy. Br J Radiol 2006;79: 719-24.

  28. Bestetti A, Carola F, Marasini B, Gatti M, Tarolo GL. Esophageal motility in systemic sclerosis and primary Raynaud’ phenomenon by esophageal scintigraphy with semisolid meal. Minerva Gastroenterol Dietol 1999;45:107-117.

  29. Martin J, Ferraro P, Duranceau A. Reflux esophagitis and scleroderma. Chest Surg Clin N Am 2001;1: 619-638.

  30. Weinstein WM, Kadell BM. The gastrointestinal tract in systemic sclerosis. In: Clements PJ, Furst DE, editors. Systemic sclerosis. Second edition. Philadelphia PA: Lippincott Williams & Wilkins; 2004. p. 293-317.

  31. Steen VD, Medsger Jr. TA. Severe organ involvement in systemic sclerosis with diffuse scleroderma. Arthritis Rheum 2000;43:2437-2444.

  32. Jaovisidla K, Csuka ME, Almargo UA, Soergel KH. Severe gastrointestinal involvement in systemic sclerosis: report of five cases and review of the literature. Sem Arthritis Rheum 2004;34:689-702.

  33. Geirsson AJ, Wollheim FA, Akesson A. Disease severity of 100 patients with systemic sclerosis over period of 14 years: using a modified Medsger scale. Ann Rheum Dis 2001;60:1117-1122.

  34. Gordon C, Kang JY, Neild PJ, Maxwell JD. The role of the hiatus hernia in gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2004;20: 719-732.

  35. Berstad A, Weberg R, Froyshov Larsen I, Hoel B, Hauer-Jensen MScand J Gastroenterol. Relationship of hiatus hernia to reflux oesophagitis. A prospective study of coincidence, using endoscopy. 1986;21:55-58.

  36. Holloway RH, Dent J. Pathophysiology of gastroesophageal reflux. Lower esophageal sphincter dysfunction in gastroesophageal reflux disease. Gastroenterol Clin North Am 1990;19:517-535.

  37. Patti MG, Goldberg HI, Arcerito M, Bortolasi L, Tong J, Way LW. Hiatal hernia size affects lower esophageal sphincter function, esophageal acid exposure, and the degree of mucosal injury. Am J Surg 1996;171:182-186.

  38. Montesi A, Pesaresi A, Cavalli ML, Serri L, Salmistraro D, Candela M, et al. Correlation between the radiologic study of deglutition and the clinical picture in systemic sclerosis (scleroderma) Radiol Med 1990;80:296-300.

  39. Duchini A, Sessoms SL. Gastrointestinal hemorrhage in patients with systemic sclerosis and CREST syndrome. Am J Gastroenterol 1998;93:1453-1456.

  40. Becvar R, Stork J, Jansa P. New trends in diagnosis and treatment of systemic sclerosis. Vnitr Lek 2006; 52:712-717.

  41. Cozzi F, Zucchetta P, Durigon N, Marzola MC, Bullo A, Favaro M, et al. Changes in esophageal peristalsis in diverse clinical forms and antibody specificity in scleroderma: a scintigraphic study in 100 cases. Reumatismo 2003;55:86-92.

  42. Wojas-Pelc A, Stepien A, Lipko-Godlewska S, Wielowieyska-Szybinska D, Zabinska-Plazak E, Kieltyka A. Esophageal scintigraphy in patients with systemic sclerosis: clinical symptoms correlated with the esophagus noted by the patients. Przegl Lek 2002;59:973-976.

  43. Ling TC, Johnston B. Esophageal investigations in connective tissue disease: which tests are most appropriate? J Clin Gastroenterol 2001;32:33-36.

  44. Nakamura T, Shirakawa K, Sotote A. A prospective endoscopic study of GERD in Japanese systemic sclerosis patients. Gastrointest Endosc 2005;61; 138-135.

  45. Vera-Lastra O. Esclerosis sistémica. Med Int Mex 2006;22:231-245.

  46. Rose S, Young MA, Reynolds JC. Gastrointestinal manifestations of scleroderma. Gastroenterol Clin North Am 1998;27:563-594.

  47. Young MA, Rose S, Reynolds JC. Gastrointestinal manifestations of scleroderma. Rheum Dis Clin North Am 1996;22:797-823.

  48. Sjögren RW. Gastrointestinal features of scleroderma. Curr Opin Rheumatol 1996;8:569-575.

  49. Goldblatt F, Gordon TP, Waterman SA. Antobodymediated gastrointestinal dysmotility in scleroderma. Gastroenterology 2002;123:1144-1150.

  50. Attar A. Digestive involvement of scleroderma. Ann Med Interne 2002;153:260-264.

  51. Sallam H, McNearney TA, Chen JD. Systematic review: pathophysiology and management of gastrointestinal dysmotility in systemic sclerosis (scleroderma). Aliment Pharmacol Ther 2006 15; 23:691-712.

  52. Bassotti G, Battaglia E, Debernardi V, Germani U, Quiriconi F, Dughera L, et al. Esophageal dysfunction in scleroderma. Arthritis Rheum 1997; 40:2252-2259.

  53. Abu-Shakra M, Guillemin F, Lee P. Gastrointestinal manifestation of systemic sclerosis. Sem Arthritis Rheum 1994;24:29-39.

  54. Hamel-Roy J, Devroede G, Arhan P, Tetreault L, Duranceau A, Menard H. Comparative esophageal and anorectal motility in scleroderma. Gastroenterology 1985;88:1-7.

  55. Clements PJ. Systemic sclerosis (scleroderma) and related disorders: clinical aspect. Baillieres Clin Rheumatol 2000;14:1-16.

  56. Roberts CG, Hummers LK, Ravich WJ, Wigley FM, Hutchins GM. A case-controlled study of the pathology of oesophageal disease in systemic. Gut 2006;55:1697-1703.

  57. Vera-Lastra O. Esclerosis sistémica y tracto gastrointestinal. Abordaje diagnóstico y terapéutico. Reumatol Clin 2006;2:24-30.

  58. Misra R, Singh G, Aggarwal P, Aggarwal A. Juvenile onset systemic sclerosis: a single center experience of 23 cases from Asia. Clin Rheumatol 2007;26(8):1259-1262.

  59. Sharma VK, Trilokraj T, Khaitan BK, Krishna SM. Profile of systemic sclerosis in a tertiary care center in North India. Indian J Dermatol Venereol Leprol 2006;72:416-420.

  60. Dantas RO, Aprile LR. Esophageal striated muscle contractions in patients with gastroesophageal reflux symptoms. Dig Dis Sci 2002;47:2586-2590.

  61. Szigeti N, Fabian G, Gomori E, Czirjak L. Barrett esophagus in systemic sclerosis. Orv Hetil 2001; 142:671-674.

  62. Wipff J, Allanore Y, Soussi F, Terris B, Abitbol V, Raymond J, et al. Prevalence of Barrett’s esophagus in systemic sclerosis. Arthritis Rheum 2005;59: 2882-2888.

  63. Niv Y, Abu-Avid S, Yelin A, Liberman Y. Barrett’s ephithelium and esophageal adenocarcinoma in scleroderma. Am J Gastroenterol 1988;83:792-793.

  64. Heath EI, Limburg PJ, Hawk ET. Adenocarcinoma of the esophagus: risk factors and prevention. Oncology (Huntingt) 2000;14:507-514.

  65. Contreras MA, Salas C, Andreu JL, Mulero J. Cytomegalovirus esophagitis as a treatable complication of systemic sclerosis. J Clin Rheumatol 2001;7: 384-387.

  66. Marie I, Dominique S, Levesque H. Esophageal involvement and pulmonary manifestations in systemic sclerosis. Arthritis Rheum 2001; 45:346-354.

  67. Ing AJ. Interstitial lung disease and gastroesophageal reflux. Am J Med 2001;111(Suppl 8A):41S-44S.

  68. Al-Amri SM. The pattern of esophageal manometry in progressive systemic sclerosis. Saudi Med J 2003; 24:68-71.

  69. Marie I. Gastrointestinal involvement in systemic sclerosis. Press Med 2006;35:1952-1965.

  70. Ebert EC. Esophageal disease in scleroderma. J Clin Gastroenterol 2006;40:769-775.

  71. Pitrez EH, Bredemeier M, Xavier RM, Capobianco KG, Restelli VG, Vieira MV, et al. Oesophageal dysmotility in systemic sclerosis: comparison of HRCT and scintigraphy. Br J Radiol 2006;79: 719-24.

  72. Bestetti A, Carola F, Marasini B, Gatti M, Tarolo GL. Esophageal motility in systemic sclerosis and primary Raynaud’ phenomenon by esophageal scintigraphy with semisolid meal. Minerva Gastroenterol Dietol 1999;45:107-117.

  73. Martin J, Ferraro P, Duranceau A. Reflux esophagitis and scleroderma. Chest Surg Clin N Am 2001;1: 619-638.

  74. Weinstein WM, Kadell BM. The gastrointestinal tract in systemic sclerosis. In: Clements PJ, Furst DE, editors. Systemic sclerosis. Second edition. Philadelphia PA: Lippincott Williams & Wilkins; 2004. p. 293-317.

  75. Steen VD, Medsger Jr. TA. Severe organ involvement in systemic sclerosis with diffuse scleroderma. Arthritis Rheum 2000;43:2437-2444.

  76. Jaovisidla K, Csuka ME, Almargo UA, Soergel KH. Severe gastrointestinal involvement in systemic sclerosis: report of five cases and review of the literature. Sem Arthritis Rheum 2004;34:689-702.

  77. Geirsson AJ, Wollheim FA, Akesson A. Disease severity of 100 patients with systemic sclerosis over period of 14 years: using a modified Medsger scale. Ann Rheum Dis 2001;60:1117-1122.

  78. Gordon C, Kang JY, Neild PJ, Maxwell JD. The role of the hiatus hernia in gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2004;20: 719-732.

  79. Berstad A, Weberg R, Froyshov Larsen I, Hoel B, Hauer-Jensen MScand J Gastroenterol. Relationship of hiatus hernia to reflux oesophagitis. A prospective study of coincidence, using endoscopy. 1986;21:55-58.

  80. Holloway RH, Dent J. Pathophysiology of gastroesophageal reflux. Lower esophageal sphincter dysfunction in gastroesophageal reflux disease. Gastroenterol Clin North Am 1990;19:517-535.

  81. Patti MG, Goldberg HI, Arcerito M, Bortolasi L, Tong J, Way LW. Hiatal hernia size affects lower esophageal sphincter function, esophageal acid exposure, and the degree of mucosal injury. Am J Surg 1996;171:182-186.

  82. Montesi A, Pesaresi A, Cavalli ML, Serri L, Salmistraro D, Candela M, et al. Correlation between the radiologic study of deglutition and the clinical picture in systemic sclerosis (scleroderma) Radiol Med 1990;80:296-300.

  83. Duchini A, Sessoms SL. Gastrointestinal hemorrhage in patients with systemic sclerosis and CREST syndrome. Am J Gastroenterol 1998;93:1453-1456.

  84. Becvar R, Stork J, Jansa P. New trends in diagnosis and treatment of systemic sclerosis. Vnitr Lek 2006; 52:712-717.

  85. Cozzi F, Zucchetta P, Durigon N, Marzola MC, Bullo A, Favaro M, et al. Changes in esophageal peristalsis in diverse clinical forms and antibody specificity in scleroderma: a scintigraphic study in 100 cases. Reumatismo 2003;55:86-92.

  86. Wojas-Pelc A, Stepien A, Lipko-Godlewska S, Wielowieyska-Szybinska D, Zabinska-Plazak E, Kieltyka A. Esophageal scintigraphy in patients with systemic sclerosis: clinical symptoms correlated with the esophagus noted by the patients. Przegl Lek 2002;59:973-976.

  87. Ling TC, Johnston B. Esophageal investigations in connective tissue disease: which tests are most appropriate? J Clin Gastroenterol 2001;32:33-36.

  88. Nakamura T, Shirakawa K, Sotote A. A prospective endoscopic study of GERD in Japanese systemic sclerosis patients. Gastrointest Endosc 2005;61; 138-135.




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