Gastrointestinal Assessment in a Large Cohort of Patients Suffering from Systemic Sclerosis

Introduction: Systemic sclerosis (SSc) is a clinically heterogeneous and generalized disease, characterized by increasing thickness of the connective tissue of the skin and internal organs such as the digestive tract and this provides severe alteration of gastrointestinal motility. Aims and Methods: We aimed to evaluate retrospectively abnormalities of esophageal motility, gastric emptying and orocecal transit time (OCTT) in a large cohort of SSc patients referring to two Italian tertiary centres. One hundred SSc patients were enrolled in the study (mean age 59±11; M/F 10/90). Forty-three patients underwent esophageal conventional manometry, 45 performed 13C octanoic breath test to measure gastric emptying time and the whole group of 100 patients was assessed by lactulose breath test in order to evaluate OCTT. Data were compared with normal values obtained in previous studies by our group. Results: In SSc patients median LES pressure [14 mmHg (25th-75th; 8-19) vs. 24 mmHg (25th-75th; 19-28); p<0.01] and median wave amplitude [30 mmHg (25th-75th; 16-70) vs. 72 mmHg (25th-75th; 48-96); p<0.01] were lower than in healthy volunteers. An abnormal esophageal involvement defined as reduced LES pressure and ineffective esophageal motility pattern was encountered in 70% of SSc patients. A delayed gastric emptying time was present in 38% of SSc patients (T ½ >135 min). The mean T ½ was 109±29 min vs. 85±50 min (p= n.s.). The median OCTT was 150min (25th-75th; 135-180 vs. 105 min, 25-75th; 90-135 p<0,01 ). Conclusion: Gastrointestinal involvement is very frequent in SSc patients. The esophagus and the small bowel are the organs more frequently impaired in scleroderma, while gastric emptying is delayed only in a small subgroup of SSc patients.