Tc. Ling et Bt. Johnston, Esophageal investigations in connective tissue disease - Which tests are most appropriate?, J CLIN GAST, 32(1), 2001, pp. 33-36
Our aim was to review the use of esophageal investigations in patients with
suspected connective tissue disease (CTD). Forty-seven patients (39 women
and 8 men) with suspected CTD were referred for esophageal manometry at the
gastrointestinal physiology unit in the Royal Victoria Hospital, Belfast,
U.K., over a 10-year period (1987-1997). The mean age was 51.7 years (range
= 21-79 years). Chart review was conducted 1 to 10 years after manometry t
o confirm the final diagnoses: scleroderma was found in 11; CREST (calcinos
is, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiect
asia), 8; mixed connective tissue disease, 14; Raynaud's alone, 5; and othe
r CTDs, 9. All 47 successfully underwent esophageal manometry. In addition
to manometry, 24 underwent gastroscopy; 27, barium meal; and 3, esophageal
pH studies. Clinically significant esophageal abnormalities were noted in 8
(33%) on gastroscopy, in 15 (56%) on barium meal, and in 31 (66%) on manom
etry. Gastroscopy had a significantly lower positivity rate than the others
(p < 0.05). Only three patients had pH testing, yet all three pH tests wer
e abnormal. During manometry, abnormal findings were significantly more com
mon in scleroderma-CREST when compared with other diagnoses (89% vs. 50%; p
< 0.02). Thirty-three patients reported dysphagia. Abnormal manometry was
more likely in these cases (82% vs. 33%; p < 0.02). A high percentage of pa
tients with CTD have significant esophageal motility disorders. Investigati
ons were more likely to be positive with scleroderma-CREST than other CTDs,
even if dysphagia was present. Barium meal and manometry are more useful t
han OGD. pH studies were under-used. There is need for a standardized appro
ach to esophageal investigations in patients with CTDs.