Abstract
The purpose of this study is to determine if frequent reflux events from an incompetent LES or poor clearance from decreased peristalsis is the predominant abnormality in PSS patients with severe reflux esophagitis. Seven patients with both classic manometric findings of PSS and endoscopic findings of esophageal ulcerations and/or Barrett's esophagus were compared to nine patients with similar endoscopic findings but with no evidence of a connective tissue disorder. All patients underwent simultaneous intraesophageal pH monitoring and scintigraphy for a total of 40 min after a radiolabeled meal. Four of the PSS patients and all the non-PSS patients had simultaneous manometry. We found that PSS patients had significantly fewer reflux events (P<0.01), but the reflux events had significantly longer duration (P<0.01) compared to patients with similar severity of esophagitis and no connective tissue disease. We conclude that decreased smooth muscle peristalsis appears to be the primary contributor to acid exposure and esophageal injury in PSS.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Poircer TJ, Rankin GB: Gastrointestinal manifestations of progressive systemic sclerosis based on a review of 364 cases. Am J Gastroenterol 58:30–44, 1972
Atkinson M, Summerling MD: Oesophageal changes in systemic sclerosis. Gut 7:402–408, 1966
Dodds WJ: Instrumentation and methods for intraluminal esophageal manometry. Arch Intern Med 136:515–523, 1976
Cohen S, Laufer I, Snape WR: The gastrointestinal manifestations of scleroderma: Pathogenesis and management. Gastroenterology 79:155–166, 1980
Zamost BJ, Hirschberg J, Ippoliti AF, Furst DE, Clements PJ, Weinstein WM: Esophagitis in scleroderma. Prevalence and risk factors. Gastroenterology 92:421–428, 1987
Stentoft P, Hendel L, Aggestrup S: Esophageal manometry and pH probe monitoring in the evaluation of gastroesophageal reflux in patients with progressive systemic sclerosis. Scand J Gastroenterol 22:499–504, 1987
Drane WE, Karvelis K, Johnson DA, Curran JJ, Silverman ED: Progressive systemic sclerosis: Radionuclide esophageal scintigraphy and manometry. Radiology 160:73–76, 1986
Netscher D, Larson GM, Polk HC: Radionuclide esophageal transit: A screening test for esophageal disorders. Arch Surg 121:843–848, 1986
Shay SS, Eggli D, Johnson LF: Simultaneous esophageal pH monitoring and scintigraphy during post prandial period in patients with severe reflux esophagitis. Dig Dis Sci 36:558–564, 1991
Masi T: Preliminary criteria for classification of systemic sclerosis (scleroderma). Subcommittee for scleroderma criteria of the American Rheumatism Association. Diagnostic and Therapeutic Criteria Committee. Arthritis Rheum 23:581–590, 1980
Dent J: A new technique for continuous sphincter pressure measurements. Gastroenterology 71:263–267, 1976
Shay SS, Eggli D, Oliver G, Peura DA, Johnson LF: Cycling, a manometric phenomenon due to repetitive episodes of gastroesophageal reflux and clearance. Dig Dis Sci 34:1340–1348, 1989
Helms JF, Dodds WJ, Pelc WR, Palmer DW, Hogan WJ: Effect of esophageal emptying and saliva on clearance of acid from the esophagus. N Engl J Med 310:284–288, 1984
Clouse RE, Ferney DM: Rhythmic spontaneous contractions in patients with esophageal symptoms. Am J Gastroenterol 81:666–671, 1986
Garrett JM, Winkelman RK, Shlegel JR, Code CF: Esophageal deterioration in scleroderma. Mayo Clin Proc 46:92–96, 1971
Creamer B, Anderson HA, Code CF: Esophageal motility in patients with scleroderma and related diseases. Gastroenterologia 86:763–775, 1956
Dodds WJ, Dent J, Hogan WJ, Helms JF, Hauser R, Patel GK, Egide MS: Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med 307:1547–1552, 1982
Dent J, Holloway RH, Toouli J, Dodds WJ: Mechanisms of lower esophageal sphincter incompetence in patients with symptomatic gastroesophageal reflux. Gut 29:1020–1028, 1988
Mittel RK, McCallum RW: Characteristics and frequency of transient relaxations of the lower esophageal sphincter in patients with reflux esophagitis. Gastroenterology 95:593–599, 1988
Johnson DA, Drane WE, Curran J, Benjamin SB, Chobanian SJ, Kastytis K, Cattau EL: Metochlopramide response in patients with progressive systemic sclerosis. Arch Intern Med 147:1597–1601, 1987
Kahan A, Amor B, Menkes CJ, Chaussade S, Gaudric M, Etienne D, Fraitag B, Couturier D: Cisapride in the treatment of esophageal abnormalities in systemic sclerosis. Gastroenterology 94:S120(A), 1988
Horowitz M, Maddern GJ, Maddox A, Wishart J, Chatterton BE, Shearman DJ: Effects of cisapride on gastric and esophageal emptying in progressive systemic sclerosis. Gastroenterology 93:311–315, 1987
Orringer MB, Orringer JS, Dabich L, Zarafonetis CJ: Combined Collis gastroplasty fundoplication operations for scleroderma reflux esophagitis. Surgery 90:624–630, 1981
Brand DL, Eastwood IR, Martin D, Carter WB, Pope CE: Esophageal symptoms, manometry, and histology before and after antireflux surgery: A long term follow up study. Gastroenterology 76:1393–1401, 1979
Author information
Authors and Affiliations
Additional information
The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.
Rights and permissions
About this article
Cite this article
Murphy, J.R., McNally, P., Peller, P. et al. Prolonged clearance is the primary abnormal reflux parameter in patients with progressive systemic sclerosis and esophagitis. Digest Dis Sci 37, 833–841 (1992). https://doi.org/10.1007/BF01300380
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01300380