title: High-resolution oesophageal manometry and 24-hour impedance-pH study in systemic sclerosis patients: association with clinical features, symptoms and severity.
abstract: OBJECTIVE
  To evaluate the associations between objectively measured gastroesophageal involvement using high-resolution manometry and 24- hour impedance-pH study, and clinical presentations in systemic sclerosis (SSc) patients.
  
  
  METHODS
  This cross-sectional study was conducted in University of Malaya Medical Centre (UMMC) with 31 consecutive SSc patients recruited into this study. Clinical symptoms of gastroesophageal involvement, high-resolution impedance-manometry and 24-hour impedance-pH monitoring were assessed. Their associations with serological features and other organ involvement were evaluated.
  
  
  RESULTS
  Twenty-five (80.6%) patients had gastroesophageal reflux disease (GORD) symptoms, mainly heartburn (45.1%), regurgitation (32.2%) and dysphagia (29%). Using manometry, oesophageal dysmotility was detected in 24 (88.9%) patients, while hypotensive lower oesophageal sphincter (LOS) was observed in 17 (63%) patients. 21 (84%) patients had GORD based on pH study. Hypotensive LOS was significantly associated with presence of digital ulcers. The main gastroesophageal symptoms were absent in majority of the SSc patients including in those with severe gastroesophageal manifestations demonstrating failed peristalsis >75%, hypotensive LOS, Demeester score >200 and acid reflux >200 per day. Demeester score >200 is associated with severity of GORD symptoms. Demeester score >200 was also associated with restrictive lung pattern (p=0.001). Significant association between GORD severity (daily number of acid reflux episodes >200) and pulmonary fibrosis was seen (p=0.030).
  
  
  CONCLUSIONS
  The presence and severity of gastroesophageal symptoms may not accurately reflect the seriousness of oesophageal involvement. GORD severity is associated with presence of restrictive lung pattern and pulmonary fibrosis. Oesophageal manometry and 24-hour pH study should be considered more frequently in the assessment of SSc patients.
authors: Division of Rheumatology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia. jazzmeen@hotmail.com.
authors: Jasmin
authors: J
authors: Raja
authors: Division of Rheumatology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Department of Rheumatology & Immunology, Singapore General Hospital, Singapore.
authors: Chin Teck
authors: CT
authors: Ng
authors: Division of Rheumatology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors: Ibrahim
authors: I
authors: Sujau
authors: Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors: Kin Fah
authors: KF
authors: Chin
authors: Division of Rheumatology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors: Sargunan
authors: S
authors: Sockalingam
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D017097:Electric Impedance; D050782:Esophageal pH Monitoring / Q000379:methods*; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008296:Malaysia; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011312:Pressure; D011379:Prognosis; D011658:Pulmonary Fibrosis / Q000175:diagnosis / Q000209:etiology; D012595:Scleroderma, Systemic / Q000150:complications* / Q000175:diagnosis; D012720:Severity of Illness Index; D012883:Skin Ulcer / Q000175:diagnosis / Q000209:etiology