title: Increased inspiratory esophagogastric junction pressure in systemic sclerosis: an add-on to antireflux barrier.
abstract: OBJECTIVE
  To investigate crural diaphragm (CD) function in systemic sclerosis (SSc) using high-resolution manometry and standardized inspiratory maneuvers.
  
  
  METHODS
  Eight SSc volunteers (average age, 40.1 years; one male) and 13 controls (average age, 32.2 years; six males) participated in the study. A high-resolution manometry/impedance system measured the esophagus and esophagogastric junction (EGJ) pressure profile during swallows and two respiratory maneuvers: sinus arrhythmia maneuver (SAM; the average of six EGJ peak pressures during 5-s deep inhalations) and threshold maneuver (TM; the EGJ peak pressures during forced inhalation under 12 and 24 cmH2O loads). Inspiratory diaphragm lowering (IDL) was taken as the displacement of the EGJ high-pressure zone during the SAM.
  
  
  RESULTS
  SSc patients had lower mean lower esophageal sphincter pressure than controls during normal breathing (19.7±2.8 mmHg vs 32.2±2.7 mmHg, P=0.007). Sinus arrhythmia maneuver pressure was higher in SSc patients than in controls (142.6±9.4 mmHg vs 104.6±13.8 mmHg, P=0.019). Sinus arrhythmia maneuver pressure normalized to IDL was also higher in SSc patients than in controls (83.8±13.4 mmHg vs 37.5±6.9 mmHg, P=0.005). Threshold maneuver pressures normalized to IDL were also greater in SSc patients than in controls (TM 12 cmH2O: 85.1±16.4 mmHg vs 43.9±6.3 mmHg, P=0.039; TM 24 cmH2O: 85.2±16.4 mmHg vs 46.2±6.6 mmHg, P=0.065). Inspiratory diaphragm lowering in SSc patients was less than in controls (2.1±0.3 cm vs 3±0.2 cm, P=0.011).
  
  
  CONCLUSIONS
  SSc patients had increased inspiratory EGJ pressure. This is an add-on to EGJ pressure and indicates that the antireflux barrier can be trained.
authors.affiliation: Miguel Ângelo Nobre e Souza, Patrícia Carvalho Bezerra, Rivianny Arrais Nobre, Esther Studart da Fonseca Holanda, Department of Clinical Medicine, Federal University of Ceará, Ceará CEP 60430-040, Brazil.
authors.forename: Miguel Ângelo
authors.initials: MÂ
authors.lastname: Nobre e Souza
authors.affiliation: Miguel Ângelo Nobre e Souza, Patrícia Carvalho Bezerra, Rivianny Arrais Nobre, Esther Studart da Fonseca Holanda, Department of Clinical Medicine, Federal University of Ceará, Ceará CEP 60430-040, Brazil.
authors.forename: Patrícia Carvalho
authors.initials: PC
authors.lastname: Bezerra
authors.affiliation: Miguel Ângelo Nobre e Souza, Patrícia Carvalho Bezerra, Rivianny Arrais Nobre, Esther Studart da Fonseca Holanda, Department of Clinical Medicine, Federal University of Ceará, Ceará CEP 60430-040, Brazil.
authors.forename: Rivianny Arrais
authors.initials: RA
authors.lastname: Nobre
authors.affiliation: Miguel Ângelo Nobre e Souza, Patrícia Carvalho Bezerra, Rivianny Arrais Nobre, Esther Studart da Fonseca Holanda, Department of Clinical Medicine, Federal University of Ceará, Ceará CEP 60430-040, Brazil.
authors.forename: Esther Studart
authors.initials: ES
authors.lastname: da Fonseca Holanda
authors.affiliation: Miguel Ângelo Nobre e Souza, Patrícia Carvalho Bezerra, Rivianny Arrais Nobre, Esther Studart da Fonseca Holanda, Department of Clinical Medicine, Federal University of Ceará, Ceará CEP 60430-040, Brazil.
authors.forename: Armênio Aguiar
authors.initials: AA
authors.lastname: dos Santos
mesh_terms: D000328:Adult; D001945:Breathing Exercises; D016022:Case-Control Studies; D003679:Deglutition; D003964:Diaphragm / Q000503:physiopathology*; D015154:Esophageal Motility Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology; D004943:Esophagogastric Junction / Q000503:physiopathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D001239:Inhalation; D008297:Male; D008365:Manometry; D011312:Pressure; D012595:Scleroderma, Systemic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012720:Severity of Illness Index
keywords: Crural diaphragm; Gastroesophageal reflux; Lower esophageal sphincter; Systemic sclerosis