Gastric involvement in systemic sclerosis: A prospective study

OBJECTIVES: This study aims to assess the prevalence of gastric electrical activity dysfunction with cutaneous electrogastrography (EGG), disturbances of gastric emptying function using radiopaque pellets, and gastric endosco pic abnormalities in patients with systemic sclerosis (SSc). We also invest igate for an association between EGG and gastric-emptying data with clinica l manifestations and esophageal motor disturbances. METHODS: Fasting and postprandial gastric electrical activity was studied i n 22 consecutive patients with SSc (17 with and 5 without clinical gastric manifestations) and 22 age- and sex-matched healthy subjects. Gastric empty ing of radiopaque pellets and gastroscopy were also performed in SSc patien ts. RESULTS: The prevalence of EGG disturbances was as high as 81.82% in SSc pa tients. SSc patients exhibited, compared with controls, higher median perce ntage of dominant frequency in bradygastria during the fasting period and l ower median values for postprandial electrical power and postprandial to fa sting ratio for electrical power. Gastric emptying of radiopaque pellets wa s delayed in 11 SSc patients, and gastroscopy demonstrated "watermelon stom ach" in 3 SSc patients. No correlation was found between the severity of ga stric impairment and clinical presentation, SSc duration and subsets, and e sophageal manometric impairment. CONCLUSIONS: Our study underlines the high frequency of gastric dysfunction in SSc patients. It suggests the usefulness of EGG in SSc in noninvasively detecting disorders of gastric electrical activity at an early stage and s ymptomatic patients with gastroparesis (because there was a correlation bet ween values of postprandial to fasting ratio for electrical power of < 1 on EGG and delayed gastric emptying). Gastric-emptying evaluation of radiopaq ue pellets may further be a helpful method to depict symptomatic SSc patien ts with gastroparesis. Finally, our series confirms that watermelon stomach diagnosis should be excluded in SSc patients presenting with gastrointesti nal hemorrhage or with anemia related to iron deficiency. (Am J Gastroenter ol 2001;96: 77-83. (C) 2001 by Am. Coll. of Gastroenterology).