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High Resolution Manometry in Scleroderma Patients
Accepted Manuscript High Resolution Manometry in Scleroderma Patients Cristina Ogliari, Nicole Piazza O Sed, Maurizio Vecchi
PII: DOI: Reference:
S1542-3565(17)30610-9 10.1016/j.cgh.2017.05.030 YJCGH 55259
To appear in: Clinical Gastroenterology and Hepatology Accepted Date: 22 May 2017 Please cite this article as: Ogliari C, O Sed NP, Vecchi M, High Resolution Manometry in Scleroderma Patients, Clinical Gastroenterology and Hepatology (2017), doi: 10.1016/j.cgh.2017.05.030. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT To the Editor: Cristina Ogliari*, Nicole Piazza O Sed*^, Maurizio Vecchi*^° *UOC Gastroenterologia IRCCS Policlinico San Donato, San Donato Milanese, Italy [email protected], +39 02 5277 4655 ^ University of Milan, ° Department of Biomedical Sciences for the Health IRCCS Policlinico San Donato Conflict of interest none to declare for any author.
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We read with interest the article by Crowell et al. regarding the prevalence and type of esophageal motor abnormalities in systemic scleroderma patients [1]. In that study, which involved 200 patients and 102 controls, the distinctive features of scleroderma esophagus (hypotensive esophagogastric junction pressure with absent contractility) were detected in only one third of patients. Moreover, the spectrum of esophageal motor abnormalities was heterogeneous, the most frequent finding being an absent contractility, as detected in 56%, followed by normal motility in 26%, and ineffective esophageal motility in 10% of patients. At multivariate logistic regression analysis, the predictors of severity of esophageal dysmotility were disease duration, the total score of Gastrointestinal Tract questionnaire and the presence of interstitial lung disease. We retrospectively reviewed data from patients with systemic scleroderma undergoing highresolution manometry at our Gastroenterology Unit from 01 June 2015 to 01 July 2016. Our series consisted of 18 patients; all were women, with a median age of 60 years (IQR 25-79 y). In agreement with Crowell et al., we found that only 3 patients (17%) had typical manometric features of scleroderma esophagus, while 44% had absent contractility and 33% normal motility. Ineffective esophageal motility was observed in only 11% of cases. The remaining 2 patients (11%) showed a jackhammer esophagus and diffuse esophageal spasm pattern. We also observed a correlation between esophageal motor pattern and lung involvement: indeed, 50% of patents with absent contractility had lung involvement. These observations confirm the evidence that scleroderma is an insidious disease, with a wide spectrum of esophageal involvement that does not always show the so-called “scleroderma esophagus.” As a consequence, diagnostic certainty may sometimes be difficult to reach. Despite the observed concordance between Crowell et al.’s data and our own, we feel that the interpretation of both studies may be limited by the inclusion of only patients with gastrointestinal symptoms. Thus, we believe that further studies involving both scleroderma asymptomatic patients and healthy asymptomatic controls are needed to fully understand the prevalence, type and clinical correlations of gastrointestinal involvement in this disease. Reference
[1] Crowell MD et al. Clin Gastroenterol Hepatol 2017 Feb; 15(2): 207-213
PII: DOI: Reference:
S1542-3565(17)30610-9 10.1016/j.cgh.2017.05.030 YJCGH 55259
To appear in: Clinical Gastroenterology and Hepatology Accepted Date: 22 May 2017 Please cite this article as: Ogliari C, O Sed NP, Vecchi M, High Resolution Manometry in Scleroderma Patients, Clinical Gastroenterology and Hepatology (2017), doi: 10.1016/j.cgh.2017.05.030. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT To the Editor: Cristina Ogliari*, Nicole Piazza O Sed*^, Maurizio Vecchi*^° *UOC Gastroenterologia IRCCS Policlinico San Donato, San Donato Milanese, Italy [email protected], +39 02 5277 4655 ^ University of Milan, ° Department of Biomedical Sciences for the Health IRCCS Policlinico San Donato Conflict of interest none to declare for any author.
AC C
EP
TE D
M AN U
SC
RI PT
We read with interest the article by Crowell et al. regarding the prevalence and type of esophageal motor abnormalities in systemic scleroderma patients [1]. In that study, which involved 200 patients and 102 controls, the distinctive features of scleroderma esophagus (hypotensive esophagogastric junction pressure with absent contractility) were detected in only one third of patients. Moreover, the spectrum of esophageal motor abnormalities was heterogeneous, the most frequent finding being an absent contractility, as detected in 56%, followed by normal motility in 26%, and ineffective esophageal motility in 10% of patients. At multivariate logistic regression analysis, the predictors of severity of esophageal dysmotility were disease duration, the total score of Gastrointestinal Tract questionnaire and the presence of interstitial lung disease. We retrospectively reviewed data from patients with systemic scleroderma undergoing highresolution manometry at our Gastroenterology Unit from 01 June 2015 to 01 July 2016. Our series consisted of 18 patients; all were women, with a median age of 60 years (IQR 25-79 y). In agreement with Crowell et al., we found that only 3 patients (17%) had typical manometric features of scleroderma esophagus, while 44% had absent contractility and 33% normal motility. Ineffective esophageal motility was observed in only 11% of cases. The remaining 2 patients (11%) showed a jackhammer esophagus and diffuse esophageal spasm pattern. We also observed a correlation between esophageal motor pattern and lung involvement: indeed, 50% of patents with absent contractility had lung involvement. These observations confirm the evidence that scleroderma is an insidious disease, with a wide spectrum of esophageal involvement that does not always show the so-called “scleroderma esophagus.” As a consequence, diagnostic certainty may sometimes be difficult to reach. Despite the observed concordance between Crowell et al.’s data and our own, we feel that the interpretation of both studies may be limited by the inclusion of only patients with gastrointestinal symptoms. Thus, we believe that further studies involving both scleroderma asymptomatic patients and healthy asymptomatic controls are needed to fully understand the prevalence, type and clinical correlations of gastrointestinal involvement in this disease. Reference
[1] Crowell MD et al. Clin Gastroenterol Hepatol 2017 Feb; 15(2): 207-213