Background/Purpose: Esophageal dysmotility is common in Systemic Sclerosis (SSc), affecting 50-80% of patients, usually associated with poor prognosis. SSc leads to atrophy and fibrosis of the smooth muscle of the esophagus, modifying peristaltic contractions and motility. Manometry is considered the gold standard for the diagnosis of esophageal motility disorders, but dilation can also be observed with computed tomography (CT), even if its diagnostic validity is still unknown. /Purpose: To compare esophageal dilation observed with CT to manometry, in patients with SSc and to confirm whether CT can be used in the assessment of esophageal dysmotility.

Methods: Forty six patients meeting the 2013 ACR/EULAR Classification Criteria for SSc, and 53 healthy controls were included and retrospectively studied. Patients with overlapping syndromes, active infections or with longstanding diabetes were excluded. Epidemiological and clinical data were collected from medical records. All patients and controls had undergone at least one manometry and one CT, requested in daily clinical practice for another purpose. The most recent exams were selected for the study. Esophageal involvement was assessed using manometry (aperistalsis, inefficient peristalsis, nonspecific dysmotility and normal peristalsis) and compared with the largest coronal esophageal luminal diameters proximally, near the carina, and distally observed by CT. Data analysis was performed by STATA. All patients signed written informed consent, approved by the Research Ethics Committee.

Results: The sample included 76 women (10 dcSSc, 28 lcSSc, 3 MCTD, 35 controls) and 23 men (3 dcSSc, 2 lcSSc, 18 controls). Esophageal dysmotility was seen in 40/46 patients with SSc (87%) by manometry (defined as inefficient peristalsis or aperistalsis). Esophageal dilation (≥10mm) was present proximally in 23/44 patients (52.3%), distally in 35/46 patients (76.1%), and near the carina in 26/44 patients (59,1%). Esophageal dilatation at any level was statistically associated with esophageal dysmotility (p<0.05). The areas under the ROC curves suggest that the esophageal proximal diameter in the coronal plane is good for detecting esophageal dysmotility (0.798, 95%CI 0.705-0.890), with the distal diameter (0,759, 95% CI 0.661-0.857) and the carinal diameter (0.712, 95%CI 0.607-0.816), being slightly lower. A proximal diameter ≥7.5 mm provides a specificity of 87.2% (95% CI: 76.7–96.7) and a sensitivity of 65.3% (95% CI: 51.9–78.6) for esophageal dysmotility, enabling correct classification of 75% of the patients. A distal diameter ≥12.9 mm provides a specificity of 76.6% (95% CI: 64.5–88.7) and a sensitivity of 71.2% (95% CI: 58.8–83.5), correctly classifying 73% of the patients.

Conclusion: CT, a less invasive technique than manometry, can be an acceptable diagnostic tool for esophageal dysmotility in SSc, when the maximum proximal or distal esophageal diameter are ≧7.5mm and 12.9mm, respectively. CT done in the daily clinical practice could be exploited when manometry is not preferred in selected patients with SSc. More studies need to be carried out to confirm this results.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluation-of-esophageal-dysmotility-in-systemic-sclerosis-clinical-value-of-computed-tomography/