Regional esophageal dysfunction in scleroderma and achalasia using multichannel intraluminal impedance and manometry.
BACKGROUND
Achalasia and scleroderma are esophageal motility abnormalities characterized by severely impaired bolus transit. Combined multichannel intraluminal impedance and manometry (MII-EM) enables the simultaneous measurement of intraesophageal pressures and bolus transit at various levels within the esophagus.


OBJECTIVE
The aim of the study was to evaluate and characterize regional pressure and transit profile differences in scleroderma and achalasia patients.


METHODS
A retrospective analysis was carried out of MII-EM studies of patients with scleroderma (15), achalasia (20), and poorly relaxing lower esophageal sphincter (LES) with normal esophageal body function (20) as a control group. Bolus presence and segmental transit were evaluated by MII.


RESULTS
In patients with achalasia, bolus transit was impaired across all four sites compared with scleroderma (P < 0.0125) even though distal esophageal pressures were higher (P < 0.05) in patients with achalasia. Pressures in patients with achalasia were similar across all four sites (ANOVA; saline, P = 0.373; viscous, P = 0.615). Bolus clearance rates and contraction amplitudes in patients with scleroderma decreased from proximal to distal. In the control group, bolus clearance was complete during > or = 83% of all swallows and esophageal pressure amplitudes increased distally.


CONCLUSIONS
While the overall bolus transit is impaired in both patients with achalasia and scleroderma regional pressure and bolus transit differences exist. Bolus transit abnormalities result from abnormal esophageal body contraction and not abnormal LES relaxation.
Mainie
Inder
I
Gastroenterology and Hepatology, Medical University South Carolina, Charleston, SC 29425, USA. indermainie@gmail.com
Tutuian
Radu
R
Patel
Alpesh
A
Castell
Donald O
DO
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017097:Electric Impedance; D004931:Esophageal Achalasia / Q000150:complications / Q000503:physiopathology*; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005772:Gastrointestinal Transit / Q000502:physiology; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D011312:Pressure; D012189:Retrospective Studies; D012595:Scleroderma, Systemic / Q000150:complications* / Q000503:physiopathology; D012720:Severity of Illness Index