Esophageal scintigraphy with a semisolid meal to evaluate esophageal dysmotility in systemic sclerosis and Raynaud's phenomenon

Esophageal transit scintigraphy seems to be a valid methodology to assess i mpaired esophageal motility in early stages of disease. The purpose of this study was to discriminate patients with primary Raynaud's phenomenon (RP) and patients with systemic sclerosis (SSc) from healthy subjects by esophag eal scintigraphy with a semisolid meal. Methods: We studied 32 patients wit h primary RP, 18 with SSc and 13 healthy subjects. Dysphagia, acid regurgit ation and heartburn were scored. After an overnight fast, all subjects unde rwent esophageal scintigraphy, using a semisolid orally ingested bolus (10 mL apple puree) labeled with Tc-99m-sulfur colloid. Esophageal transit and emptying time and integral value were evaluated with the subjects in the up right (sitting) and supine positions. Transit time was defined as the time from the entry of 50% of radioactivity into the upper esophagus until the c learance of 50% of the bolus from the whole esophagus. Emptying time was de fined as the time from the entry of 50% of radioactivity into the upper eso phagus, until the clearance of 100% of the bolus from the whole esophagus. Integral Value was defined as the total counts under the time-activity curv e normalized to the maximum. Results: Esophageal transit and emptying time and integral value, evaluated in both positions, were significantly higher in patients with SSc than in healthy subjects and than in patients with RP. Moreover, patients with RP had all three parameters, assessed in supine po sition, significantly longer compared to healthy subjects. Clinical scores regarding dysphagia, acid regurgitation and heartburn were not significantl y different between patients with RP and SSc. Conclusion: Esophageal transi t and emptying time and integral Value appear to be able to discriminate pa tients with primary RP from patients with SSc and patients with RP from hea lthy subjects, suggesting an early mild esophageal dysfunction in RP.