Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Division of Rheumatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Neurogastroenterol Motil. 2022 Jul;34(7):e14284. doi: 10.1111/nmo.14284. Epub 2021 Oct 28.
Although esophageal dysmotility is common in systemic sclerosis (SSc)/scleroderma, little is known regarding the pathophysiology of motor abnormalities driving reflux severity and dysphagia. This study aimed to assess primary and secondary peristalsis in SSc using a comprehensive esophageal motility assessment applying high-resolution manometry (HRM) and functional luminal imaging probe (FLIP) Panometry.
A total of 32 patients with scleroderma (28 female; ages 38-77; 20 limited SSc, 12 diffuse SSc) completed FLIP Panometry and HRM. Secondary peristalsis, i.e., contractile responses (CR), was classified on FLIP Panometry by pattern of contractility as normal (NCR), borderline (BCR), impaired/disordered (IDCR), or absent (ACR). Primary peristalsis on HRM was assessed according to the Chicago classification.
The manometric diagnoses were 56% (n = 18) absent contractility, 22% (n = 7) ineffective esophageal motility (IEM), and 22% (n = 7) normal motility. Secondary peristalsis (CRs) included 38% (n = 12) ACR, 38% (n = 12) IDCR, 19% (n = 6) BCR, and 15% (n = 5) NCR. The median (IQR) esophagogastric junction (EGJ) distensibility index (DI) was 5.8 mm /mmHg (4.8-10.1) mm /mmHg; EGJ-DI was >8.0 mm /mmHg in 31%, and >2.0 mm /mmHg in 100% of patients. Among 18 patients with absent contractility on HRM, 11 had ACR, 5 had IDCR, and 2 had BCR. Among 7 patients with IEM, 1 had ACR, 5 had IDCR, and 1 NCR. All of the patients with normal peristalsis had NCR or BCR.
This was the first study assessing combined HRM and FLIP Panometry in a cohort of SSc patients, which demonstrated heterogeneity in primary and secondary peristalsis. This complementary approach facilitates characterizing esophageal function in SSc, although future study to examine clinical outcomes remains necessary.
尽管食管动力障碍在系统性硬化症（SSc）/硬皮病中很常见，但对于驱动反流严重程度和吞咽困难的运动异常的病理生理学知之甚少。本研究旨在使用综合食管动力评估，包括高分辨率测压（HRM）和功能腔内成像探头（FLIP） Panometry，评估 SSc 中的原发性和继发性蠕动。
共有 32 名硬皮病患者（28 名女性；年龄 38-77 岁；20 名局限性 SSc，12 名弥漫性 SSc）完成了 FLIP Panometry 和 HRM。继发性蠕动，即收缩反应（CR），在 FLIP Panometry 上根据收缩力模式分类为正常（NCR）、边界（BCR）、受损/紊乱（IDCR）或不存在（ACR）。HRM 上的原发性蠕动根据芝加哥分类进行评估。
测压诊断为 56%（n=18）无收缩力、22%（n=7）无效食管动力（IEM）和 22%（n=7）正常动力。继发性蠕动（CRs）包括 38%（n=12）ACR、38%（n=12）IDCR、19%（n=6）BCR 和 15%（n=5）NCR。胃食管交界处（EGJ）可扩张指数（DI）的中位数（IQR）为 5.8mm /mmHg（4.8-10.1）mm /mmHg；31%的患者 EGJ-DI>8.0mm /mmHg，100%的患者 EGJ-DI>2.0mm /mmHg。在 18 名 HRM 上无收缩力的患者中，11 名患者为 ACR，5 名患者为 IDCR，2 名患者为 BCR。在 7 名 IEM 患者中，1 名患者为 ACR，5 名患者为 IDCR，1 名患者为 NCR。所有具有正常蠕动的患者均为 NCR 或 BCR。
这是第一项在 SSc 患者队列中评估 HRM 和 FLIP Panometry 联合应用的研究，该研究显示原发性和继发性蠕动存在异质性。这种互补的方法有助于描述 SSc 中的食管功能，尽管仍需要进一步研究来检查临床结果。
