AB1211 ESOPHAGEAL INVOLVEMENT AND CORRELATIONS WITH PATIENT CHARACTERISTICS IN SYSTEMIC SCLEROSIS (MONOCENTRIC STUDY)
Authors: M. Annunziata, M. Brancaccio, M. L. Marchesano, A. Milone, C. Parlati, M. Patrone, F. Riccio, F. Ciccia, G. Cuomo
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Gastrointestinal tract involvement is the main cause of morbidity in individuals with Systemic Sclerosis. Esophageal manifestations are reported in approximately 90% of patients. Esophageal disease is characterized by altered functioning of the muscles in the lower part of the esophagus (Cohen et al, 1972). This results in reduced peristalsis and lower esophageal sphincter incompetence, leading to episodes of dysphagia and reflux responsible for esophagitis, with an increased risk of developing Barrett's esophagus. <h3>Objectives:</h3> The objective of the study is to assess the frequency of esophageal manifestations and their correlations with the clinical characteristics of SSc. <h3>Methods:</h3> Retrospective analysis was conducted on data from 550 patients diagnosed with Systemic Sclerosis according to ACR/EULAR criteria in a monocentric cohort, followed at our clinic from 2016 to 2021. Our cohort comprises 89% females and 11% males; the disease subset is represented by limited cutaneous form in 54.5% of cases and diffuse cutaneous form in 45.5%; 63.6% of patients exhibit anti-centromere antibodies, and 36.4% show anti-SCL70 antibodies. The following esophageal alterations were assessed: dysmotility, reflux (GERD), and Barrett's esophagus. <h3>Results:</h3> In our patient cohort, esophageal involvement was identified in 480 patients (87%). Specifically, we observed: Motility disorders in 400 patients (83%); Gastroesophageal reflux (GERD) in 380 patients (79%); Barrett's esophagus in 20 patients (4%). Furthermore, we analyzed the correlation between esophageal involvement and clinical disease manifestations, noting that: Esophageal dysmotility is associated with telangiectasias (p=0.01), calcinosis (p=0.03), and digital ulcers (p=0.035); GERD correlates with the positivity of anti-centromere antibodies (p=0.01) and cardiac involvement (p=0.02). In a retrospective study, SCL-70 positive patients reported a higher risk of dysphagia (p=0.027), while ACA-positive patients had a significantly lower risk (p=0.046). Barrett's esophagus correlates with the limited subset of the disease (p=0.04). Consistent with our data, a study conducted at the University of Pennsylvania on 75 SSc patients suggests that esophageal abnormalities may be more frequently associated with the limited cutaneous subtype of SSc; however, other conflicting data suggest that it may occur independently of the cutaneous subtype and disease duration. <h3>Conclusion:</h3> Esophageal involvement is highly prevalent in our patient cohort, and our data align with those of other monocentric cohorts. Both esophageal dysmotility and GERD correlate with various clinical manifestations of the disease. Additionally, 18-40% of SSc patients may have asymptomatic esophageal dysmotility. Estimating the severity of Scleroderma (SSc) solely based on the results of esophagogastroduodenoscopy (EGDS) may therefore underestimate esophageal motility disorders, making it necessary to perform esophageal manometry.REFERENCES: NIL. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>