POS0818 CHARACTERISTICS OF JAPANESE PATIENTS WITH SYSTEMIC SCLEROSIS WITH DYSPHAGIA A SINGLE-CENTER STUDY
Authors: T. Naganawa, S. Shibata, T. Hashimoto, N. Ikeda, H. Takase, N. Dosoden, K. Ito, M. Sawada, Y. Ito, N. Watanabe, A. Umeda, K. Ashihara, M. Kurumizawa, J. Nishino, S. Fukaya, Y. Inamoto, Y. Otaka, H. Yasuoka
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Systemic sclerosis (Scleroderma; SSc) is a rare autoimmune connective tissue disease characterized by vasculopathy and fibrosis leading to progressive dysfunction of multiple organs. In 90 % of patients with SSc, the upper gastrointestinal tract is typically involved especially in esophageal lesions such as peristalsis and/or gastroesophageal reflux disease (GERD) due to fibrosis of the esophagus. However whether dysphagia is an unique organ involvement or associated with SSc itself is still unclear, since there are a few reports mentioning dysphagia in SSc. But the presence and the amount of pharyngeal residue can enhance the risk of aspiration in patients with dysphagia in general, which is also explained by the existence of esophageal lesion. <h3>Objectives:</h3> In this study, we evaluated the prevalence of dysphagia in SSc based on the evaluation by aspiration and laryngeal penetration using a videofluoroscopic (VF) swallowing study. <h3>Methods:</h3> Fifty consecutive patients with Scleroderma (SSc) who were examined VF swallowing study were included. Dysphagia was identified by the existence of residue and aspiration and/or laryngeal penetration evaluated by the Penetration-Aspiration Scale (PAS). The residue defined esophageal involvement (E) after swallowing a liquid bolus, pharyngeal involvement (P) by the presence of vallecular residue, and gut involvement (G) by the presence of diarrhea. <h3>Results:</h3> In 50 patients with SSc, 78 % was female. The age at VF was 63.4 ± 13.2 years. Based on the PAS, 27 (54%) had no laryngeal penetration, 21 (42%) had laryngeal penetration, and 2 (4%) had aspiration. As for the association with components of GI involvements in 50 patients, E was found in 48 (96%), P in 41 (82%), and G in 25 (50%). Most of E had P (40/48, 83%), and almost half of P had G (22/40, 55%). All with G had E (100%), and most of G was with P (22/25, 88%). The E+P+G+ group had a younger onset (p = 0.024), was more frequent with aspiration and/or laryngeal penetration (p = 0.006), and had a higher UCLA GIT-2.0 (p = 0.002) compared with patients with E+P. As for the association with clinical characteristics, aspiration and/or laryngeal penetration was associated with esophageal residue (p = 0.008), diarrhea (p = 0.004), a UCLA GIT-2.0 total score (p = 0.006), and HAQ-DI (p = 0.017), and had a tendency with pharyngeal residue, reflux and prefrail/frail by the univariate analysis. Dysphagia based on aspiration and/or laryngeal penetration was associated with pharyngeal residue (p = 0.012), esophageal residue (p = 0.01), diarrhea (p = 0.006), and UCLA GIT-2.0 (p = 0.048) by the multivariate analysis <h3>Conclusion:</h3> Almost half of the patients were affected by dysphagia in patients with SSc. Pharyngeal involvement can be included in upper GI involvement, but not independent organ involvement. The results suggests that the emergence of dysphagia and/or esophageal involvement is an earlier stage of GI involvement. Thus, VF might be a good tool to detect dysphagia earlier for patients with SSc. <h3>REFERENCES:</h3> [1] Romy B Christmann, Athol U Wells, Vera L Capelozzi, et al. Gastroesophageal reflux incites interstitial lung disease in systemic sclerosis: clinical, radiologic, histopathologic, and treatment evidence. Semin Arthritis Rheum 2010;40:241-9. [2] Edith Eisenhuber, Wolfgang Schima, Ewald Schober, et al. Videofluoroscopic assessment of patients with dysphagia: pharyngeal retention is a predictive factor for aspiration. Am J Roentgenol 2002;178:393-8. <h3>Acknowledgements:</h3> We thank Takuma Ishihara and Ayumi Shintani for the Biostatistics technical support. <h3>Disclosure of Interests:</h3> <b>None declared.</b>