AB1179 ESOPHAGEAL DYSMOTILITY IN SYSTEMIC SCLEROSIS: DEMOGRAPHIC AND CLINICAL FINDINGS
Authors: R. Ferreira, I. Santos, C. Gomes, M. Diz Lopes, G. Terroso, L. Costa
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The relationship between manometric changes and esophageal dilation on high-resolution computed tomography (HRCT) is well established in Systemic Sclerosis (SSc),<sup>[1]</sup> but its association with extra-esophageal manifestations is inconsistent<sup>[2,3]</sup>. <h3>Objectives:</h3> This study aims to characterize manometric findings in SSc patients and to determine predictive factors of manometric esophageal body involvement. <h3>Methods:</h3> This is a retrospective single-center study including adult patients with SSc registered in Reuma.pt fulfilling ACR/EULAR 2013 classification criteria who had undergone conventional or high-resolution esophageal manometry (HRM). Patients with prior upper gastrointestinal (UGI) surgery or myositis overlap were excluded. Demographic and clinical data were collected. The associations between esophageal motility and disease duration, immunologic profile, cutaneous and pulmonary involvement, as well as endoscopic or tomographic esophageal alterations were evaluated. <h3>Results:</h3> A total of 76 patients were included. Manometric characterization was performed (Table 1). Sixty patients (78.9%) underwent a conventional manometry. The most common finding was aperistalsis in 23 (38.3%), followed by normal peristalsis in 21 (35.0%), hypoperistalsis in 13 (21.7%) and nutcracker esophagus in 3 (5.0%). A normotonic lower esophageal sphincter (LES) was present in 45 (75.0%), hypotonic in 14 (23.3%) and hypertonic in 1 (1.7%). HRM was performed in 16 patients (21.1%). Normal motility was seen in 9 (56.3%), ineffective esophageal motility and absent contractility in 3 each (18.8%) and esophagogastric junction outflow obstruction in 1 (6.3%). A normotonic LES was present in 9 (56.3%) and a hypotonic LES in 7 (43.8%). Altogether, manometric studies revealed a total of 46 patients (60.5%) with esophageal body dysmotility and 54 (71.1%) with normotonic LES. Baseline characteristics were analyzed globally and by motility group (Table 2). Sixty-four patients (84.2%) had limited cutaneous disease. The median disease duration was 5 years (IQR 11) with mean age of 54.1±12.4 years. Seventy-one patients (93.4%) were females. Potential predictive factors of manometric involvement were compared between patients with normal motility and dysmotility (Table 3). Esophageal dilation on HRCT was more frequent in patients with dysmotility (p=0.005). There were no statistically significant differences regarding disease duration, immunologic profile (antinuclear, anti-Scl70 or anticentromere antibodies), modified Rodnan skin score, esophagitis, Barrett's esophagus, interstitial lung disease, forced vital capacity or single-breath carbon monoxide diffusing capacity. <h3>Conclusion:</h3> Esophageal involvement was frequent in our sample, although LES was more commonly spared. An association between esophageal dysmotility and its dilation on HRCT was found, highlighting the utility of HRCT for identification of UGI involvement in SSc. No association was found between manometric changes and extra-esophageal manifestations. <h3>REFERENCES:</h3> [1] Salaffi F, Di Carlo M, Carotti M, Fraticelli P, Gabrielli A, Giovagnoni A. Relationship between interstitial lung disease and oesophageal dilatation on chest high-resolution computed tomography in patients with systemic sclerosis: a cross-sectional study. Radiol Med. 2018;123(9):655-663. [2] Markus J, Pinto RMC, Matoso AGB, Ranza R. Esophageal manometry in systemic sclerosis: findings and association with clinical manifestations. Rev Assoc Med Bras. 2020;66(1):48-54. [3] Kimmel JN, Carlson DA, Hinchcliff M, et al. The association between systemic sclerosis disease manifestations and esophageal high-resolution manometry parameters. Neurogastroenterol Motil. 2016;28(8):1157-1165. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>