title: Irritable bowel syndrome and organic diseases: a comparative analysis of esophageal motility.
abstract: OBJECTIVE
  To assess the esophageal motility in patients with irritable bowel syndrome (IBS) and to compare those with patients with autoimmune disorders.
  
  
  METHODS
  15 patients with IBS, 22 with systemic lupus erythematosus (SLE) and 19 with systemic sclerosis (SSc) were prospectively selected from a total of 115 patients at a single university centre and esophageal motility was analysed using standard manometry (Mui Scientific PIP-4-8SS). All patients underwent esophago-gastro-duodenoscopy before entering the study so that only patients with normal endoscopic findings were included in the current study. All patients underwent a complete physical, blood biochemistry and urinary examination. The grade of dysphagia was determined for each patient in accordance to the intensity and frequency of the presented esophageal symptoms. Furthermore, disease activity scores (SLEDAI and modified Rodnan score) were obtained for patients with autoimmune diseases. Outcome parameter: A correlation coefficient was calculated between amplitudes, velocity and duration of the peristaltic waves throughout esophagus and patients' dysphagia for all three groups.
  
  
  RESULTS
  There was no statistical difference in the standard blood biochemistry and urinary analysis in all three groups. Patients with IBS showed similar pathologic dysphagia scores compared to patients with SLE and SSc. The mean value of dysphagia score was in IBS group 7.3, in SLE group 6.73 and in SSc group 7.56 with a P-value > 0.05. However, the manometric patterns were different. IBS patients showed during esophageal manometry peristaltic amplitudes at the proximal part of esophagus greater than 60 mmHg in 46% of the patients, which was significant higher in comparison to the SLE (11.8%) and SSc-Group (0%, P = 0.003). Furthermore, IBS patients showed lower mean resting pressure of the distal esophagus sphincter (Lower esophageal sphincter, 22 mmHg) when compared with SLE (28 mmHg, P = 0.037) and SSc (26 mmHg, P = 0.052). 23.5% of patients with SLE showed amplitudes greater as 160 mmHg in the distal esophagus (IBS and SSc: 0%) whereas 29.4% amplitudes greater as 100 mmHg in the middle one (IBS: 16.7%, SSc: 5.9% respectively, P = 0.006). Patients with SSc demonstrated, as expected, in almost half of the cases reduced peristalsis or even aperistalsis in the lower two thirds of the esophagus. SSc patients demonstrated a negative correlation coefficient between dysphagia score, amplitude and velocity of peristaltic activity at middle and lower esophagus [r = -0.6, P < 0.05].
  
  
  CONCLUSIONS
  IBS patients have comparable dysphagia-scores as patients with autoimmune disorders. The different manometric patterns might allow differentiating esophageal symptoms based on IBS from other organic diseases.
authors.affiliation: Thomas Thomaidis, Markus Moehler, Peter Robert Galle, Andreas Schwarting, Medical Clinic, Johannes-Gutenberg University, 55131 Mainz, Rheinland-Pfalz, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Thomaidis
authors.forename: Martin
authors.initials: M
authors.lastname: Goetz
authors.forename: Sebastian Paul
authors.initials: SP
authors.lastname: Gregor
authors.forename: Arthur
authors.initials: A
authors.lastname: Hoffman
authors.forename: Elias
authors.initials: E
authors.lastname: Kouroumalis
authors.forename: Markus
authors.initials: M
authors.lastname: Moehler
authors.forename: Peter Robert
authors.initials: PR
authors.lastname: Galle
authors.forename: Andreas
authors.initials: A
authors.lastname: Schwarting
authors.forename: Ralf
authors.initials: R
authors.lastname: Kiesslich
mesh_terms: D000328:Adult; D015551:Autoimmunity; D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D016145:Endoscopy, Digestive System; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D005858:Germany; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010528:Peristalsis; D011446:Prospective Studies; D012595:Scleroderma, Systemic / Q000150:complications / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Dysphagia; Esophageal manometry; Irritable bowel syndrome; Systemic lupus erythematosus; Systemic sclerosis