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Background: Systemic sclerosis (SSc) is chronic, autoimmun multisystem disorder presented by thickening and fibrosis of the skin and internal organs. Esophageal involvement is one of the most common manifestation. Esophageal enlargement on HRCT is a common finding in scleroderma patients and may also be associated with other scleroderma-related clinical findings (1).
Objectives: The aim of this study to evaluate the association between esophageal dilatation on chest HRCT at diagnosis with the other SSc features.
Methods: The study was planned for SSc patients registered between October 2007 and September 2020 in Dokuz Eylul University Rheumatology Department database. Demographics, clinical features and medical history were recorded. The baseline HRCT reports were screened in terms of esophageal dilatation. Then, the initial HRCT images were assessed for esophageal dilatation by an experienced chest radiologist according to recommendation of Pitrez et al.
Results: In our study, there were 233 SSc patients (f:206 M:27, mean age 59.9±12.7 years) 71 (31.4%) of them diagnosed with diffuse disease. Median follow-up of study was 73 (1-272) months. Esophageal dilatation on HRCT was detected in 60 (25.8%) of SSc patients. 67 out of 155 patients (43.2%) had proof of esophageal involvement in esophageal transit scintigraphy. There is no statistical correlation was found between esophageal dilatation on HRCT with gender, smoking, arthritis, pulmonary hypertension and autoantibody subtypes. Development of digital ulcer and telangiectasia is statistically higher in SSc patients with oesophageal dilatation on baseline chest HRCT (p=0.001 and p=0.039, respectively). There was a positive correlation between Modified Rodnan Skin Score (mRss) and esophageal dilatation (r=0.213, p: 0.004).
Conclusion: HRCT can be a reproducible and non-invasive method for evaluating esophageal dilatation. Presence of esophageal dilatation at baseline HRCT might be indicative for pulmonary involvement and SSc related gastrointestinal complications. Consecutive chest HCRT should be evaluated to obtain more reliable data about the relationship between esophageal dilatation and SSc related clinical features.
REFERENCES:
[1]Pitrez EH, Bredemeier M, Xavier RM et al .Ooesophageal dysmotility in systemic sclerosis:comparison of HRCT and scintigraphy. Br J Radiol 2006; 79: 719–24.
Clinical and demographic characteristics of the presence of esophageal dilatation on HRCT
| Esophageal dilatation on HRCT | |||||||
| Total (n=233) | Yes (n=60, 25.8%) | No (n=173, 74.2%) | p | ||||
| Mean±SD. | Mean±SD. | Mean±SD. | |||||
| Age, years | 59.9±12.7 | 59.7±12.2 | 60.1 ±12.6 | >0.05 | |||
| n | % | n | % | n | % | ||
| Female | 206 | 88,4% | 53 | 88,3% | 149 | 86,1% | >0.05 |
| Smoking | 79 | 33,9% | 19 | 31,7% | 60 | 34,7% | >0.05 |
| Diffuse SSc | 71 | 30,5% | 23 | 38,3% | 44 | 25,4% | >0.05 |
| Overlap syndrome | 33 | 14,2% | 8 | 13,3% | 25 | 14,5% | >0.05 |
| Pulmonary fibrosis | 118 | 50,6% | 42 | 70,0% | 76 | 43,9% | >0.05 |
| Arthritis | 80 | 34,3% | 23 | 38,3% | 56 | 32,4% | >0.05 |
| Telengiectasia | 156 | 67,0% | 48 | 80,0% | 105 | 60,7% | 0,039 |
| Digital ulcer | 87 | 37,3% | 34 | 56,7% | 51 | 29,5% | 0,001 |
| Anti-Scl 70 (+ ) | 89 | 38,2% | 28 | 46,7% | 59 | 34,1% | >0.05 |
| Anti-centromer (+ ) | 75 | 32,2% | 15 | 25,0% | 59 | 34,1% | >0.05 |
Disclosure of Interests: None declared