title: Esophageal and anorectal involvement in systemic sclerosis: a systematic assessment with high resolution manometry.
abstract: OBJECTIVE
  In systemic sclerosis (SSc), esophageal and anorectal involvements are frequent and often associated with each other. In clinical practice, esophageal explorations are often prescribed, while anorectal explorations are rarely proposed and therefore, under-recognised. However, it is well documented in the literature that early detection of anorectal dysfunction could delay and/or prevent the onset of symptoms such as fecal incontinence (FI). The main objective was the systematic evaluation and detection of esophageal and anorectal involvements in SSc patients.
  
  
  METHODS
  In this monocentric retrospective study, all patients with SSc addressed in the Department of Functional Digestive Explorations, North Hospital, Marseille for esophageal and anorectal explorations were included. Self-Questionnaires, evaluating the symptoms and quality of life, were filled by patients during their visit. Explorations were performed on the same day: high resolution esophageal manometry (EHRM), 3 Dimensional high resolution anorectal manometry (3DHRARM) and endo anal sonography (EUS).
  
  
  RESULTS
  44 patients (41 women), mean age 59.8±12 years, were included. With regard to the symptoms, 45.5% of patients had gastro-esophageal reflux disease (GERD), 66.9% dysphagia, 65.9% constipation and 77.3% FI. The incidence of esophageal dismotility was 65.9%, anorectal and both upper and lower dysfunction were 43.2%. More than 89% patients with abnormal explorations (EHRM, 3DHRARM or both) were symptomatic. Duration of SSc and altered quality of life was correlated with the severity of digestive involvement.
  
  
  CONCLUSIONS
  Anorectal dysfunction appears to be closely linked to esophageal involvement in SSc. Their routine screening is undoubtedly essential to limit the occurrence of severe symptoms such as FI.
authors.affiliation: Department of Gastroenterology, Instruction Hospital of French Army Laveran, Marseille, France. laure.luciano@hotmail.fr.
authors.forename: Laure
authors.initials: L
authors.lastname: Luciano
authors.affiliation: Internal Medicine Department, CHU Nord, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University; and Vascular Research Center of Marseille, INSERM UMRS-1076, Aix-Marseille University, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Granel
authors.affiliation: Internal Medicine Department, CHU La Timone, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Bernit
authors.affiliation: Internal Medicine Department, CHU La Timone, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University, France.
authors.forename: Jean-Robert
authors.initials: JR
authors.lastname: Harle
authors.affiliation: Aix-Marseille University, School of Medicine, France.
authors.forename: Karine
authors.initials: K
authors.lastname: Baumstarck
authors.affiliation: Department of Gastroenterology, CHU Nord Aix-Marseille University, Plateforme d'Interface Clinique CRN2M UMR 7286, Aix-Marseille University, Marseille, France.
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Grimaud
authors.affiliation: Department of Gastroenterology, CHU Nord Aix-Marseille University, Plateforme d'Interface Clinique CRN2M UMR 7286, Aix-Marseille University, Marseille, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Bouvier
authors.affiliation: Department of Gastroenterology, CHU Nord Aix-Marseille University, Plateforme d'Interface Clinique CRN2M UMR 7286, Aix-Marseille University, Marseille, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Vitton
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003248:Constipation / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D003672:Defecation; D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D019160:Endosonography; D004947:Esophagus / Q000503:physiopathology*; D005242:Fecal Incontinence / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D005260:Female; D005602:France; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D005769:Gastrointestinal Motility; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011312:Pressure; D011788:Quality of Life; D012007:Rectum / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires