Esophageal investigations in connective tissue disease: which tests are most appropriate?
Our aim was to review the use of esophageal investigations in patients with suspected connective tissue disease (CTD). Forty-seven patients (39 women and 8 men) with suspected CTD were referred for esophageal manometry at the gastrointestinal physiology unit in the Royal Victoria Hospital, Belfast, U.K., over a 10-year period (1987-1997). The mean age was 51.7 years (range = 21-79 years). Chart review was conducted 1 to 10 years after manometry to confirm the final diagnoses: scleroderma was found in 11; CREST (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia), 8; mixed connective tissue disease, 14; Raynaud's alone, 5; and other CTDs, 9. All 47 successfully underwent esophageal manometry. In addition to manometry, 24 underwent gastroscopy; 27, barium meal; and 3, esophageal pH studies. Clinically significant esophageal abnormalities were noted in 8 (33%) on gastroscopy, in 15 (56%) on barium meal, and in 31 (66%) on manometry. Gastroscopy had a significantly lower positivity rate than the others (p < 0.05). Only three patients had pH testing, yet all three pH tests were abnormal. During manometry, abnormal findings were significantly more common in scleroderma-CREST when compared with other diagnoses (89% vs. 50%; p < 0.02). Thirty-three patients reported dysphagia. Abnormal manometry was more likely in these cases (82% vs. 33%; p < 0.02). A high percentage of patients with CTD have significant esophageal motility disorders. Investigations were more likely to be positive with scleroderma-CREST than other CTDs, even if dysphagia was present. Barium meal and manometry are more useful than OGD. pH studies were under-used. There is need for a standardized approach to esophageal investigations in patients with CTDs.
Ling
T C
TC
Lagan Valley Hospital, Lisburn, North Ireland.
Johnston
B T
BT
D000328:Adult; D000368:Aged; D001466:Barium Sulfate; D003240:Connective Tissue Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism; D003287:Contrast Media / Q000008:administration & dosage; D015154:Esophageal Motility Disorders / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism; D004947:Esophagus / Q000000981:diagnostic imaging / Q000378:metabolism; D005260:Female; D005773:Gastroscopy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011859:Radiography; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000378:metabolism
D003287:Contrast Media; D001466:Barium Sulfate