There are significant correlations between esophageal motility abnormalities (EMAs) and severe skin thickness, according to a study published in the Journal of Gastroenterology.
EMAs and interstitial lung diseases (ILDs) are commonly seen in patients with systemic sclerosis (SSc). Gastroesophageal reflux disease (GERD) may also be associated with ILDs. However, it is unclear if ILDs are caused by GERD or SSc itself.
In this retrospective study, researchers sought to clarify relationships between ESAs and skin involvements by selecting consecutive patients with SSc who underwent high-resolution esophageal manometry between May 2009 and August 2016 (N = 109). SSc was classified into 2 types: diffuse cutaneous SSc (dcSSc) and limited cutaneous SSc (lcSSc). Esophageal motility was evaluated with high-resolution manometry. The Rodnan total skin thickness score (mRSS) was used to evaluate the severity of skin thickness, and high-resolution computer tomography (HRCT) was used to assess the severity ILDs.
Overall, 44 patients had normal esophageal motility, 9 had major esophageal motility abnormalities except absent contractility, 27 had ineffective esophageal motility, and 29 had absent contractility (AC). Compared with patients with normal esophageal motility, patients with AC had significantly higher mRSS scores (P <.05); patients with AC also tended to have higher HRCT scores, although this difference did not reach statistical significance (P =.05). GERD was not a significant predictor for ILDs.
Limitations of this study included its retrospective design and missing data. Generalizability is limited because the data acquired were from a single hospital and all participants were Japanese. Patients with ineffective esophageal motility were not included in the analyses because multiple rapid swallow was not performed. GERD events were not evaluated by impedance/pH monitoring.
This is the first study in which a multivariable analysis was performed to reveal the relationship between EMAs and skin involvements. “When SSc was divided into  types, dcSSc and lcSSc, the difference in the prevalence of dcSSc between patients with abnormal contractility and those with normal esophageal motility did not reach statistical significance,” the researchers noted. “Assessing both the extent and severity of skin thickness is useful to predict the presence of esophageal motility abnormalities in patients with SSc.”
Kuribayashi S, Motegi SI, Hara K, et al. Relationship between esophageal motility abnormalities and skin or lung involvements in patients with systemic sclerosis. J Gastroenterol. 2019;54(11):950-962.