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. Esophageal motility abnormalities, mainly hypomotility pattern, are frequently encountered in SSc patients. After esophagus, small bowel and stomach are the most common gastrointestinal target in SSc. Aim To assess the correlation between the oro-cecal transit time (OCTT) and manometric motility abnormalities of the esophagus, in a cohort of SSc patients. Methods We enrolled in the study 43 consecutive ambulatory SSc (Limited SSc: 28 patients Diffuse SSc: 17 patients), independently from GI complaints. Patients underwent both 10g lactulose breath test (LBT) to determine oro-cecal transit time (OCTT) and conventional esophageal manometry to assess the impairment of esophageal motility (IEM). Results Median lower esophageal sphincter (LES) pressure and median wave amplitude were both significantly lower than in healthy volunteers [14 mmHg (25th-75th; 8-19) vs. 24 mmHg (25th-75th; 19-28); p<0.01] and [30 mmHg (25th-75th; 16-70) vs. 72 mmHg (25th-75th; 48-96); p<0.01]. Median OCTT resulted to be significantly longer in SSc patients then in healthy controls: 165min (25th-75th;142-180) vs 105 (25th-75th; 90-135); p<0.01. OCTT resulted to be significantly longer in patients with IEM compared to patients with normal esophageal motility (141¡À27 vs 163¡À18, respectively ; p=0.003) The prevalence of IEM in SSc patients was higher in patients with longer OCTT, in effect the prevalence of IEM was significantly lower in patients with an OCTT <150min (3/11) as compared with patients with an OCTT ¡Ý150min (24/32), (27% vs. 75%, respectively, OR= 3.0; p=0.004). Conclusion -Abnormalities of both esophageal and small intestine motility are more frequent as compared to controls. -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 ¡Ý150min. -The prevalence of IEM in SSc patients with an OCTT >180min is higher than 80%.
LACTULOSE BREATH TEST IS A NON-INVASIVE TOOL TO ASSESS ESOPHAGEAL INVOLVEMENT IN SCLERODERMA PATIENTS
Negrini S;
2010-01-01
Abstract
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. Esophageal motility abnormalities, mainly hypomotility pattern, are frequently encountered in SSc patients. After esophagus, small bowel and stomach are the most common gastrointestinal target in SSc. Aim To assess the correlation between the oro-cecal transit time (OCTT) and manometric motility abnormalities of the esophagus, in a cohort of SSc patients. Methods We enrolled in the study 43 consecutive ambulatory SSc (Limited SSc: 28 patients Diffuse SSc: 17 patients), independently from GI complaints. Patients underwent both 10g lactulose breath test (LBT) to determine oro-cecal transit time (OCTT) and conventional esophageal manometry to assess the impairment of esophageal motility (IEM). Results Median lower esophageal sphincter (LES) pressure and median wave amplitude were both significantly lower than in healthy volunteers [14 mmHg (25th-75th; 8-19) vs. 24 mmHg (25th-75th; 19-28); p<0.01] and [30 mmHg (25th-75th; 16-70) vs. 72 mmHg (25th-75th; 48-96); p<0.01]. Median OCTT resulted to be significantly longer in SSc patients then in healthy controls: 165min (25th-75th;142-180) vs 105 (25th-75th; 90-135); p<0.01. OCTT resulted to be significantly longer in patients with IEM compared to patients with normal esophageal motility (141¡À27 vs 163¡À18, respectively ; p=0.003) The prevalence of IEM in SSc patients was higher in patients with longer OCTT, in effect the prevalence of IEM was significantly lower in patients with an OCTT <150min (3/11) as compared with patients with an OCTT ¡Ý150min (24/32), (27% vs. 75%, respectively, OR= 3.0; p=0.004). Conclusion -Abnormalities of both esophageal and small intestine motility are more frequent as compared to controls. -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 ¡Ý150min. -The prevalence of IEM in SSc patients with an OCTT >180min is higher than 80%.
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