Luciano Laure, Granel Brigitte, Bernit Emmanuelle, Harle Jean-Robert, Baumstarck Karine, Grimaud Jean-Charles, Bouvier Michel, Vitton Véronique
Department of Gastroenterology, Instruction Hospital of French Army Laveran, Marseille, France.
Internal Medicine Department, CHU Nord, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University; and Vascular Research Center of Marseille, INSERM UMRS-1076, Aix-Marseille University, France.
Clin Exp Rheumatol. 2016 Sep-Oct;34 Suppl 100(5):63-69. Epub 2016 May 24.
In systemic sclerosis (SSc), esophageal and anorectal involvements are frequent and often associated with each other. In clinical practice, esophageal explorations are often prescribed, while anorectal explorations are rarely proposed and therefore, under-recognised. However, it is well documented in the literature that early detection of anorectal dysfunction could delay and/or prevent the onset of symptoms such as fecal incontinence (FI). The main objective was the systematic evaluation and detection of esophageal and anorectal involvements in SSc patients.
In this monocentric retrospective study, all patients with SSc addressed in the Department of Functional Digestive Explorations, North Hospital, Marseille for esophageal and anorectal explorations were included. Self-Questionnaires, evaluating the symptoms and quality of life, were filled by patients during their visit. Explorations were performed on the same day: high resolution esophageal manometry (EHRM), 3 Dimensional high resolution anorectal manometry (3DHRARM) and endo anal sonography (EUS).
44 patients (41 women), mean age 59.8±12 years, were included. With regard to the symptoms, 45.5% of patients had gastro-esophageal reflux disease (GERD), 66.9% dysphagia, 65.9% constipation and 77.3% FI. The incidence of esophageal dismotility was 65.9%, anorectal and both upper and lower dysfunction were 43.2%. More than 89% patients with abnormal explorations (EHRM, 3DHRARM or both) were symptomatic. Duration of SSc and altered quality of life was correlated with the severity of digestive involvement.
Anorectal dysfunction appears to be closely linked to esophageal involvement in SSc. Their routine screening is undoubtedly essential to limit the occurrence of severe symptoms such as FI.
在系统性硬化症（SSc）中，食管和肛门直肠受累很常见，且常常相互关联。在临床实践中，经常会进行食管检查，而肛门直肠检查很少被建议，因此未得到充分认识。然而，文献中有充分记载，早期发现肛门直肠功能障碍可以延缓和/或预防诸如大便失禁（FI）等症状的出现。主要目的是系统评估和检测SSc患者的食管和肛门直肠受累情况。
在这项单中心回顾性研究中，纳入了所有在马赛北部医院功能性消化检查科进行食管和肛门直肠检查的SSc患者。患者在就诊期间填写了评估症状和生活质量的自我问卷。在同一天进行检查：高分辨率食管测压（EHRM）、三维高分辨率肛门直肠测压（3DHRARM）和肛门内超声检查（EUS）。
纳入了44例患者（41名女性），平均年龄59.8±12岁。关于症状，45.5%的患者有胃食管反流病（GERD），66.9%有吞咽困难，65.9%有便秘，77.3%有FI。食管动力障碍的发生率为65.9%，肛门直肠以及上下功能障碍的发生率为43.2%。超过89%检查异常（EHRM、3DHRARM或两者均异常）的患者有症状。SSc的病程和生活质量改变与消化受累的严重程度相关。
肛门直肠功能障碍似乎与SSc中的食管受累密切相关。对它们进行常规筛查无疑对于限制诸如FI等严重症状的发生至关重要。
