Skip to main content

Videofluorography swallow study of patients with systemic sclerosis

Studio videofluorografico della deglutizione in pazienti affetti da sclerodermia sistemica

Abstract

Purpose

This study was undertaken to evaluate the role of the videofluorographic (VFG) swallow study in patients with systemic sclerosis.

Materials and methods

Over a 23-month period, 45 women (mean age 58 years, range 27–76 years) with a known diagnosis of systemic sclerosis and a history of dysphagia underwent a dynamic and morphological study of the oral, pharyngeal and oesophageal phases of swallowing with videofluorography. All examinations were performed with a remote-controlled digital C-arm device with 16-in image intensifier, 0.6- to 1.2-mm focal spot range and maximum tube voltage of 150 kVp in fluorography and 120 kVp in fluoroscopy. Cineradiographic sequences were acquired for the swallow study with 12 images per second and matrix 512×512 after the ingestion of boluses of high-density (250% weight/volume) barium. The evaluation of oesophageal peristalsis was documented with digital cineradiographic sequences with six images per second in the upright and supine positions during the swallowing of barium (60% weight/volume), and the water siphon test was performed with the patient in the supine position to evaluate the presence of gastro-oesophageal reflux disease (GORD). All patients subsequently underwent laryngoscopy, endoscopy and pH monitoring, and the data thus obtained were processed and compared.

Results

The VFG swallow study identified alterations of epiglottal tilting associated with intraswallowing laryngeal penetration in 26 patients (57.8%), pooling of contrast agent in the valleculae and pyriform sinuses in 23 (51.1%) and radiographic signs of nonspecific hypertrophy of the lingual and/or palatine tonsils in 18 (40%). The study of the oesophageal phase revealed the presence of altered peristalsis in all patients, and in particular, 36 patients (80%) showed signs of atony. Altered oesophageal clearing mechanisms were evident in all 45 patients, sliding hiatus hernia in 43 (93%) and GORD in 44 (97%).

Conclusions

Our study demonstrated that in patients with systemic sclerosis, there is no primary alteration of the oral or pharyngeal phase of swallowing. In addition, alterations of epiglottal tilting associated with laryngeal penetration of contrast agent were found to be secondary to chronic GORD. Indeed, in 40% of patients, radiographic signs were found that indicated nonspecific hypertrophy of the lingual tonsil and/or palatine tonsils and nonspecific signs of chronic pharyngeal inflammation, and GORD was identified in 93% of patients, which in 40% of cases extended to the proximal third of the oesophagus. The data obtained were confirmed in 85% of cases with pH monitoring and in all cases with laryngoscopy.

Riassunto

Obiettivo

Valutare il ruolo dello studio videofluorografico (VFG) nella valutazione della deglutizione in pazienti affetti da sclerodermia sistemica.

Materiali e metodi

In un periodo di 23 mesi 45 pazienti di sesso femminile (età media 58 anni; range 27–76 anni), con diagnosi certa di sclerodermia, che riferivano anamnesticamente disfagia sono stati sottoposti a studio dinamico e morfologico del tratto oro-faringeo della deglutizione e del tratto faringo-esofageo-cardiale mediante videofluorografia. Tutti gli esami sono stati eseguiti con apparecchio telecomandato con arco a C digitale dotato di intensificatore di brillanza da 16 pollici, macchia focale da 0,6 a 1,2 mm e massima differenza di potenziale di 150 pkV in grafia e 120 pkV in scopia. Per lo studio della deglutizione sono state acquisite sequenze cineradiografiche digitali con 12 immagini/secondo con matrice 512×512 previa ingestione di boli progressivi di MdC baritato ad alta densità (250% P/V). La valutazione della peristalsi esofagea è stata documentata con sequenze cineradiografiche digitali con 6 immagini/secondo, in ortostasi e clinostasi durante deglutizione di boli di bario (60% P/V) ed, infine, è stato effettuto, in clinostasi, il test del sifone d’acqua (WST) per la valutazione del reflusso gastroesofageo (GERD). Tutti i pazienti sono stati sottoposti successivamente a valutazione laringoscopica, endoscopica e pH-metrica, i dati così ottenuti sono stati rielaborati e confrontati.

Risultati

Lo studio della funzione deglutitoria, effettuato mediante VFG, ha evidenziato alterazioni del tilting epiglottico associato a fenomeni di penetrazione subepiglottica intradeglutitoria in 26 pazienti (57,8%), ristagno del MdC in corrispondenza delle vallecule glosso-epiglottiche e dei seni piriformi in 23 (51,1%) e segni radiografici di ipertrofia aspecifica della tonsilla linguale e/o delle tonsille palatine in 18 (40%). Lo studio del viscere esofageo ha evidenziato la presenza di alterazioni della peristalsi nella totalità della popolazione ed in particolare 36 pazienti (80%) manifestavano evidenti segni di atonia. In tutti i 45 pazienti si apprezzavano alterazioni dei meccanismi di clearing esofageo, in 42 (93%) ernia jatale da scivolamento ed in 44 (97%) reflusso gastro-esofageo.

Conclusioni

Il nostro studio ha evidenziato come, in pazienti affetti da sclerodermia sistemica non vi è un’alterazione primitiva della fase orale o faringea della deglutizione. Inoltre le alterazioni del ribaltamento dell’epiglottide (tilting) associate a fenomeni di penetrazione subepiglottica del MdC, si sono dimostrate secondarie ad insulto cronico da GERD. Infatti nel 40% dei pazienti, sono stati evidenziati segni radiografici riferibili ad un’ipertrofia aspecifica della tonsilla linguale e/o delle tonsille palatine segni aspecifici di flogosi cronica faringea ed è stato, inoltre, identificato GERD, nel 93% dei pazienti che, nel 40% dei casi, si estendeva sino al III prossimale del viscere. I dati ottenuti sono stati confermati nell’85% anche da valutazione pH-metrica e nella totalità dei casi da valutazione laringoscopica.

This is a preview of subscription content, access via your institution.

References/Bibliografia

  1. 1.

    LeRoy EC, Black C, Fleischmajer R, et al (1988) Scleroderma (systemic sclerosis): classification subsets and pathogenesis. J Rheumatol 15:202–205

    PubMed  CAS  Google Scholar 

  2. 2.

    Medsger TAJr (1994) Epidemiology of systemic sclerosis. Clin Derm 12:207–216

    Article  Google Scholar 

  3. 3.

    Ebert EC (2006) Esophageal disease in scleroderma. J Clin Gastroenterol 40:769–675

    PubMed  Article  Google Scholar 

  4. 4.

    Marie I (2006) Gastrointestinal involvement in systemic sclerosis. Presse Med 35:1952–1965

    PubMed  Article  Google Scholar 

  5. 5.

    Ntoumazios SK, Voulgari PV, Potsis K et al (2006) Esophageal involvement in scleroderma: gastroesophageal reflux, the common problem. Semin Arthritis Rheum 36:173–181

    PubMed  Article  Google Scholar 

  6. 6.

    Lock G, Holstege A, Lang B, Scholmerich J (1997) Gastrointestinal manifestations of progressive systemic sclerosis. Am J Gastroenterol 92:763–771

    PubMed  CAS  Google Scholar 

  7. 7.

    Ott DJ, Richter JE, Chen YM et al (1987) Esophageal radiography and manometry: correlation in 172 patients with dysphagia. AJR Am J Roentgenol 149:307–311

    PubMed  CAS  Google Scholar 

  8. 8.

    Pan JJ, Levine MS, Redfern RO et al (2003) Gastroesophageal reflux: comparison of barium studies with 24-h pH monitoring. Eur J Radiol 47:149–153

    PubMed  Article  Google Scholar 

  9. 9.

    Wipff J, Allanore Y, Soussi F et al (2005) Prevalence of Barrett’s esophagus in systemic sclerosis. Arthritis Rheum 52:2882–2888

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Fiorentino E, Cabibi D, Barbiera F et al (2004) Hiatal hernia, gastrooesophageal reflux and oesophagitis: videofluorographic, endoscopic and histopathological correlation. Chir Ital 56:483–488

    PubMed  Google Scholar 

  11. 11.

    Fiorentino E, Barbiera F, Cupido G et al (2003) Supra-esophageal manifestations of gastroesophageal reflux, a different diagnostic approach and an indication for laparoscopic Nissen fundoplication: our experience. Chir Ital 55:791–796

    PubMed  Google Scholar 

  12. 12.

    Barbiera F, Condello S, De Palo A et al (2006) Role of videofluorography swallow study in management of dysphagia in compromised patients. Radiol Med (Torino) 111:818–827

    Article  CAS  Google Scholar 

  13. 13.

    Lo Re G, Galia M, La Grutta L et al (2007) Digital cineradiographic study of swallowing in patients with amyotrophic lateral sclerosis. Radiol Med 112:1173–1187

    PubMed  Article  Google Scholar 

  14. 14.

    Brusori S, Braccaioli L, Bnà C et al (2001) Role of videofluorography in the study of esophageal motility disorders. Radiol Med (Torino) 101:125–132

    CAS  Google Scholar 

  15. 15.

    Scharitzer M, Pokieser P, Schober E et al (2002) Morphological findings in dynamic swallowing studies of symptomatic patients. Eur Radiol 12:1139–1144

    PubMed  Article  Google Scholar 

  16. 16.

    Ott DJ, Pikna LA (1993) Clinical and videofluoroscopic evaluation of swallowing disorders. AJR Am J Roentgenol 161:507–513

    PubMed  CAS  Google Scholar 

  17. 17.

    Montesi A, Pesaresi A, Cavalli ML et al (1991) Oropharyngeal and esophageal function in scleroderma. Dysphagia 6:219–223

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Torrico S, Corazziari E, Habib FI (2003) Barium studies for detecting esophagopharyngeal reflux events. Am J Med 115:124S–129S

    PubMed  Article  Google Scholar 

  19. 19.

    Gromet M, Homer MJ, Carter BL (1982) Lymphoid hyperplasia at the base of the tongue. Radiology 144:825–828

    PubMed  CAS  Google Scholar 

  20. 20.

    Logemann JA (1994) Dysfagia: evaluation and treatment. Folia Phoniatr Logop 47:140–164

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to S. Russo.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Russo, S., Lo Re, G., Galia, M. et al. Videofluorography swallow study of patients with systemic sclerosis. Radiol med 114, 948–959 (2009). https://doi.org/10.1007/s11547-009-0416-4

Download citation

Keywords

  • Scleroderma
  • Dysphagia
  • Gastro-oesophageal reflux disease
  • Videofluorography (VFG)

Parole chiave

  • Sclerodermia
  • Disfagia
  • Reflusso gastro-esofageo
  • Videofluorografia (VFG)