Esophageal motor activity was measured by intra-esophageal pressure recordings in 53 patients with scleroderma and 29 patients with other collagen diseases. The purpose of the study was to determine the relationship of motor abnormalities to esophageal symptoms, to compare the abnormalities in scleroderma with those in other collagen diseases, and to try to increase understanding of the responsible mechanism. Methacholine was given to 36 of the 53 patients with scleroderma to confirm that the Mecholyl test is negative in scleroderma and to see whether intraluminal pressure changes accompany the resulting improvement in esophageal emptying.
Abnormalities in the intraluminal pressure response of the esophagus to deglutition were seen in 79% of the patients with scleroderma. Of those with an abnormal swallowing pattern, 62% showed diminution or absence of the lower esophageal sphincter pressure zone. Although changes in swallowing pattern did not correlate with esophageal symptoms, absence of lower esophageal sphincter pressure did. The 29 patients with other collagen diseases had similar but less severe abnormalities in the motor response to deglutition. Usually there was better preservation of the lower esophageal sphincter. Neither abnormality correlated with esophageal symptoms in this group.
The Mecholyl test was negative in patients with scleroderma. No significant change was found in the pressure studies after methacholine.
Of the 66 patients who had both X-ray and manometric studies of the esophagus, intraluminal pressure studies showed aperistalsis in all patients without peristalsis on X-ray studies as well as in 18 patients who appeared to show normal esophageal peristalsis on X-ray studies.
1.From the Department of Internal Medicine (Gastroenterology Section and Simpson Memorial Institute)The University of Michigan Medical School, and the Clinical Research Unit of the University of Michigan HospitalAnn Arbor