Esophageal dysfunction in scleroderma - Relationship with disease subsets
Esophageal dysfunction in scleroderma - Relationship with disease subsets
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DOI：
10.1002/art.1780401222
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发表时间：
1997-12-01
影响因子：
--
通讯作者：
Emanuelli, G
中科院分区：
文献类型：
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作者：
Bassotti, G;Battaglia, E;Emanuelli, G
Objective.研究非选择性硬皮病患者食管功能与疾病程度之间的关系，并研究一组临床表现更严重的硬皮病患者的胃和小肠动力。本文采用放射学、内镜、测压和测压技术对125例硬皮病患者的食管功能进行了研究。81例患者中有55例（68%）发现食管放射学异常，125例患者中有45例（36%）发现食管炎。胃肠道症状、影像学异常、食管炎分级和各种疾病亚组之间无显著相关性，然而，内镜下食管炎的总体发生率（无论程度如何）与患者亚组显著相关（P < 0.05），在皮肤受累更严重的患者（III型）中食管炎的发生率为100%。在80%的患者中记录了测压异常，在78%的患者中记录了病理性反流。食管测压异常的严重程度与疾病的严重程度显著相关，而与pH测量数据无相关性。10例接受胃窦十二指肠测压的女性患者中有90%显示异常结果;其中60%显示神经性，30%显示肌病性模式。后者被记录在一个更严重的阶段的疾病（III型）的患者。观察到硬皮病子集与食道（可能还有更远端的肠道）运动受累的严重程度之间存在直接关系。由于食管症状和测压异常的严重程度之间没有发现相关性，测压应被认为是记录“食管”疾病严重程度的最重要的GI检查。胃和小肠测压也可能提供广泛肠道受累的证据，并为更有针对性的治疗方法提供依据。
Objective. To investigate the relationship between esophageal function and the extent of disease in a nonselected group of scleroderma patients, and to study gastric and small bowel motility in a group of scleroderma patients with more severe clinical manifestations.Methods. Esophageal function in 125 scleroderma patients was investigated by radiologic, endoscopic, manometric, and pa-metric techniques, Ten patients also underwent gastrointestinal (GI) manometric recording, both during fasting and after a standard meal.Results. Radiologic abnormalities of the esophagus were found in 55 of 81 patients (68%) and esophagitis in 45 of 125 (36%). No significant relationship was disclosed between GI symptoms, radiologic abnormalities, esophagitis grade, and the various disease subsets, However, the overall incidence of endoscopic esophagitis (irrespective of the degree) was significantly (P < 0.05) correlated with the patient subgroups, with 100% incidence of esophagitis in those having the more severe cutaneous involvement (type III). Manometric abnormalities were documented in 80% of patients, and pathologic reflux in 78%. The severity of esophageal abnormalities on manometry significantly correlated with the severity of the disease, whereas no correlations were found with pH-metric data. Ninety percent of the 10 female patients undergoing antroduodenal manometry displayed abnormal findings; of these, 60% showed neuropathic, and 30% myopathic, patterns. The latter were recorded in patients with a more severe stage of the disease (type III).Conclusion. A direct relationship was observed between scleroderma subsets and the severity of esophageal (and, probably, more distal gut) motor involvement. Since no correlation was found between esophageal symptoms and the severity of manometric abnormalities, manometry should be considered the single most important GI test to document the severity of the "esophageal" disease. Gastric and small bowel manometry may also offer evidence of widespread gut involvement, and provide a rationale for a more targeted therapeutic approach.