Annals of Nuclear Medicine

, Volume 23, Issue 9, pp 771–776 | Cite as

Esophageal transit scintigraphy and structured questionnaire in patients with systemic sclerosis with endoscopically proven reflux esophagitis

  • Kenichi NakajimaEmail author
  • Anri Inaki
  • Takashi Hiramatsu
  • Minoru Hasegawa
  • Manabu Fujimoto
  • Kazuhiko Takehara
  • Seigo Kinuya
Original Article



Esophageal complications are common in patients with systemic sclerosis (SSc). The relationship between gastroesophageal reflux (GER) symptoms and dysmotility was examined in endoscopically confirmed patients suspected of having reflux esophagitis.


A total of 32 patients with limited and diffuse type SSc (lSSc, dSSc) were examined based on a structured questionnaire score (QS) of GER symptoms, retention fraction of esophageal scintigraphy at 90 s (R 90) and gastric emptying time.


The QS was significantly higher in the reflux esophagitis group than in the non-esophagitis group (5.4 ± 3.5, 1.4 ± 2.9, P = 0.003). When the non-esophagitis group was further divided into lSSc and dSSc groups, R 90 was higher in the reflux esophagitis group (31 ± 18%) and the non-esophagitis group with dSSc (34 ± 32%) than in the non-esophagitis group with lSSc (8 ± 3%, P = 0.02). Both high R 90 ≥ 15% and QS ≥ 4 indicated reflux esophagitis. Conversely, both normal R 90 and QS indicated no reflux esophagitis.


A combination of esophageal scintigraphy and structured questionnaire demonstrated different aspects of esophageal dysfunction, namely dysmotility and GER. Patients with high QS and dysmotility may be indicated for further evaluation including endoscopic examination and medical treatment.


Systemic sclerosis Esophageal transit scintigraphy Esophageal dysmotility Gastroesophageal reflux Structured questionnaire 



This work was supported by funds for research on intractable diseases from the Ministry of Health, Labour and Welfare of Japan (2006–2008).


  1. 1.
    D’angelo W, Fries J, Masi A, Shulman L. Pathologic observation in systemic sclerosis (scleroderma). A study of fifty-eight autopsy cases and fifty-eight matched controls. Am J Med. 1969;46:428–40.CrossRefPubMedGoogle Scholar
  2. 2.
    Pitrez EH, Bredemeier M, Xavier RM, Capobianco KG, Restelli VG, Vieira MV, et al. Oesophageal dysmotility in systemic sclerosis: comparison of HRCT and scintigraphy. Br J Radiol. 2006;79:719–24.CrossRefPubMedGoogle Scholar
  3. 3.
    Mariani G, Boni G, Barreca M, Bellini M, Fattori B, AlSharif A, et al. Radionuclide gastroesophageal motor studies. J Nucl Med. 2004;45:1004–28.PubMedGoogle Scholar
  4. 4.
    Klein HA, Wald A, Graham TO, Campbell WL, Steen VD. Comparative studies of esophageal function in systemic sclerosis. Gastroenterology. 1992;102:1551–6.PubMedGoogle Scholar
  5. 5.
    Davidson A, Russell C, Littlejohn GO. Assessment of esophageal abnormalities in progressive systemic sclerosis using radionuclide transit. J Rheumatol. 1985;12:472–7.PubMedGoogle Scholar
  6. 6.
    Russell CO, Hill LD, Holmes ER 3rd, Hull DA, Gannon R, Pope CE 2nd. Radionuclide transit: a sensitive screening test for esophageal dysfunction. Gastroenterology. 1981;80:887–92.PubMedGoogle Scholar
  7. 7.
    Maddern GJ, Horowitz M, Jamieson GG, Chatterton BE, Collins PJ, Roberts-Thomson P. Abnormalities of esophageal and gastric emptying in progressive systemic sclerosis. Gastroenterology. 1984;87:922–6.PubMedGoogle Scholar
  8. 8.
    Carette S, Lacourciere Y, Lavoie S, Halle P. Radionuclide esophageal transit in progressive systemic sclerosis. J Rheumatol. 1985;12:478–81.PubMedGoogle Scholar
  9. 9.
    Nakajima K, Kawano M, Kinuya K, Sato S, Takehara K, Tonami N. The diagnostic value of oesophageal transit scintigraphy for evaluating the severity of oesophageal complications in systemic sclerosis. Nucl Med Commun. 2004;25:375–81.CrossRefPubMedGoogle Scholar
  10. 10.
    Ntoumazios SK, Voulgari PV, Potsis K, Koutis E, Tsifetaki N, Assimakopoulos DA. Esophageal involvement in scleroderma: gastroesophageal reflux, the common problem. Semin Arthritis Rheum. 2006;36:173–81.CrossRefPubMedGoogle Scholar
  11. 11.
    LeRoy EC, Black C, Fleischmajer R, Jablonska S, Krieg T, Medsger TA Jr, et al. Scleroderma (systemic sclerosis): classification, subsets and pathogenesis. J Rheumatol. 1988;15:202–5.PubMedGoogle Scholar
  12. 12.
    LeRoy EC, Medsger TA Jr. Criteria for the classification of early systemic sclerosis. J Rheumatol. 2001;28:1573–6.PubMedGoogle Scholar
  13. 13.
    Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–80.PubMedCrossRefGoogle Scholar
  14. 14.
    Numans ME, de Wit NJ. Reflux symptoms in general practice: diagnostic evaluation of the Carlsson-Dent gastro-oesophageal reflux disease questionnaire. Aliment Pharmacol Ther. 2003;17:1049–55.CrossRefPubMedGoogle Scholar
  15. 15.
    Carlsson R, Dent J, Bolling-Sternevald E, Johnsson F, Junghard O, Lauritsen K, et al. The usefulness of a structured questionnaire in the assessment of symptomatic gastroesophageal reflux disease. Scand J Gastroenterol. 1998;33:1023–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Nagano K, Kubo M, Goto M, Tatsuta M, Iishi H, Kanda T, et al. The diagnosis of GERD: a study by questionnaire (QUEST) in patients complaining upper digestive symptoms [in Japanese]. J New Rem Clin. 1998;47:841–51.Google Scholar
  17. 17.
    Weston S, Thumshirn M, Wiste J, Camilleri M. Clinical and upper gastrointestinal motility features in systemic sclerosis and related disorders. Am J Gastroenterol. 1998;93:1085–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Wegener M, Adamek RJ, Wedmann B, Jergas M, Altmeyer P. Gastrointestinal transit through esophagus, stomach, small and large intestine in patients with progressive systemic sclerosis. Dig Dis Sci. 1994;39:2209–15.CrossRefPubMedGoogle Scholar
  19. 19.
    Tsugeno H, Mizuno M, Fujiki S, Okada H, Okamoto M, Hosaki Y, et al. A proton-pump inhibitor, rabeprazole, improves ventilatory function in patients with asthma associated with gastroesophageal reflux. Scand J Gastroenterol. 2003;38:456–61.CrossRefPubMedGoogle Scholar
  20. 20.
    Kinuya K, Nakajima K, Kinuya S, Michigishi T, Tonami N, Takehara K. Esophageal hypomotility in systemic sclerosis: close relationship with pulmonary involvement. Ann Nucl Med. 2001;15:97–101.CrossRefPubMedGoogle Scholar
  21. 21.
    Nakajima K, Kawano M, Kinami S, Fujimura T, Miwa K, Tonami N. Dual-radionuclide simultaneous gastric emptying and bile transit study after gastric surgery with double-tract reconstruction. Ann Nucl Med. 2005;19:185–91.CrossRefPubMedGoogle Scholar
  22. 22.
    Marie I, Ducrotte P, Denis P, Hellot MF, Levesque H. Oesophageal mucosal involvement in patients with systemic sclerosis receiving proton pump inhibitor therapy. Aliment Pharmacol Ther. 2006;24:1593–601.CrossRefPubMedGoogle Scholar
  23. 23.
    Lock G, Pfeifer M, Straub RH, Zeuner M, Lang B, Scholmerich J, et al. Association of esophageal dysfunction and pulmonary function impairment in systemic sclerosis. Am J Gastroenterol. 1998;93:341–5.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Society of Nuclear Medicine 2009

Authors and Affiliations

  • Kenichi Nakajima
    • 1
    Email author
  • Anri Inaki
    • 1
  • Takashi Hiramatsu
    • 1
  • Minoru Hasegawa
    • 2
  • Manabu Fujimoto
    • 2
  • Kazuhiko Takehara
    • 2
  • Seigo Kinuya
    • 1
  1. 1.Department of Nuclear MedicineKanazawa University HospitalKanazawaJapan
  2. 2.Department of DermatologyKanazawa University HospitalKanazawaJapan

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