DETECTION OF EARLY ASYMPTOMATIC ESOPHAGEAL DYSFUNCTION IN SYSTEMIC-SCLEROSIS USING A NEW SCINTIGRAPHIC GRADING METHOD

Objective. To screen patients with systemic sclerosis (SSc) for esopha geal disease and to demonstrate a new system of grading dysmotility; t o determine the relationship between the symptom of dysphagia and the degree of hypomotility shown by scintigraphy. Methods. 301 patients wi th SSc were studied by esophageal scintigraphy using a semisolid orall y ingested bolus to detect esophageal dysfunction and gastroesophageal reflux. A new system of grading was used to quantitate the degree of dysfunction, ranging from grade 0 (normal) to grade 4 (severe abnormal ity). Results. 246 (82%) patients in the study population had evidence of esophageal hypomotility. Gastroesophageal reflux was noted in 83 ( 28%) patients. The largest number of patients (33%) were found to have grade 2 abnormalities. The number of patients with reflux decreased w ith increasing severity of grade, from grade 2 to grade 4 (35 to 13%). A retrospective study of the symptoms of 50 of the total study popula tion showed that increasing seventy of grade correlated with increasin g mean duration of SSc. There was no significant relationship between disease subset and the presence or severity of esophageal hypomotility . 60% of patients in grades 1 and 2 (i.e. with observed dysmotility sh own on scintigraphy) had no symptoms of dysphagia. In the more severe grades (scan grades 3 and 4), symptoms of dysphagia correlated with in crease in grade. Conclusion. Symptoms may be unreliable in judging the presence and extent of esophageal disease in SSc. Esophageal scintigr aphy is a useful noninvasive screening test for the detection of asymp tomatic disease. The new grading system provides information that rapi dly identifies the stage of esophageal disease and gives comparative d ata for followup and interventional studies.