Lactulose Breath Test Is a Non-Invasive Tool to Assess Esophageal Involvement in Scleroderma Patients

Introduction: Esophageal motility abnormalities, mainly hypomotility pattern, are frequently encountered in patients with systemic sclerosis (SSc). After esophagus, small bowel is the most common gastrointestinal target in SSc. Lactulose breath test (LBT) is a non-invasive diagnostic tool to evaluate intestinal motility. Aims and Methods: We aimed to assess the correlation between the oro-cecal transit time (OCTT) and manometric motility abnormalities in a cohort of SSc patients. We enrolled 43 consecutive SSc patients (mean age 58±10; M/ F 6/37). All patients underwent esophageal conventional manometry with 10 boluses of 5ml of water and a 240min 10g LBT in order to evaluate esophageal motility and OCTT, respectively. The diagnosis of ineffective esophageal motility (IEM) was based on the presence of distal wave low amplitude in ≥30% of wet swallows. OCTT was defined as the rising branch of hydrogen peak, proving to be higher than 10 ppm compared to baseline. Results: Twenty-seven out of 43 SSc patients were diagnosed as affected by IEM (63%), while the remaining 16 (37%) ones had normal esophageal motility. We observed a median OCTT of 165min (25th-75th, 142-180). The prevalence of IEM was significantly lower in patients with an OCTT <150min (3/11) as compared with patients with an OCTT ≥150min (24/ 32), (27% vs. 75%, respectively, OR= 3.0; p=0.004). The prevalence of IEM in patients with an OCTT >180min was 83.3%. Conclusion: LBT is a non-invasive and cheap diagnostic tool which allowed us to estimate intestinal involvement and also to predict a higher risk of esophageal hypomotility in SSc patients, who have an OCTT ≥150min.