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Evidence for oesophageal and anorectal involvement in very early systemic sclerosis (VEDOSS): report from a single VEDOSS/EUSTAR centre
  1. Gemma Lepri1,
  2. Serena Guiducci1,
  3. Silvia Bellando-Randone1,
  4. Iacopo Giani2,
  5. Cosimo Bruni1,
  6. Jelena Blagojevic1,
  7. Giulia Carnesecchi1,
  8. Alessandra Radicati1,
  9. Filippo Pucciani3,
  10. Matucci-Cerinic Marco1
  1. 1Department of Biomedicine, Division of Rheumatology AOUC and Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
  2. 2General Surgery, USL-8 Arezzo, Arezzo, Italy
  3. 3Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
  1. Correspondence to Professor Matucci-Cerinic Marco, Division of Rheumatology AOUC, Denothe Centre, Department of Biomedicine, University of Florence, Villa Monna Tessa, Viale Pieraccini 18, Florence 50139, Italy; cerinic{at}unifi.it

Abstract

Background The oesophagus is the first gastrointestinal (GI) tract involved in systemic sclerosis (SSc), followed by the anorectum.

Objective Evaluation of oesophageal and anorectal involvement and their correlations in patients with very early diagnosis of SSc (VEDOSS).

Patients and methods 59 patients with VEDOSS, evaluated with oesophageal and anorectal manometry and investigated with lung function tests and chest HRCT. Demographic data, oesophageal and anorectal symptoms, Raynaud's phenomenon, autoantibodies, videocapillaroscopy patterns, puffy fingers and digital ulcers were recorded for all patients.

Results In 4 patients oesophageal manometry and in 17 patients anorectal manometry was not performed because of scarce tolerance. Oesophageal peristalsis was absent in 14 patients; its pressure and speed were significantly lower in 41 patients (p<0.001 and p=0.005, respectively). The maximum pressure and mean pressure (Pmax and Pm) of lower oesophageal sphincter were significantly lower (p=0.012 and p=0.024, respectively). Patients with a diffusing capacity of the lung for carbon monoxide<80% presented a hypotonic lower oesophageal sphincter (p=0.008) and an abnormal peristalsis (p<0.001); patients with a diffusing capacity of the lung for carbon monoxide>80% showed only an abnormal peristalsis (<0.001). The anal resting pressure (ARP) at 4.3 cm and 2 cm from anal edge and the anal canal Pm were significantly decreased (p<0.001 and p=0.010, respectively). The maximum voluntary contraction was significantly abnormal in its Pmax and Pm (p=0.017 and p=0.005) and in its duration (p=0.001). In patients with a positive HRCT, the ARP and the canal Pmax and Pm were significantly lower; patients with negative HRCT presented only an abnormal ARP.

Conclusions In patients with VEDOSS, oesophageal and anorectal disorders are frequently detected, showing that very early SSc is characterised by GI involvement.

  • Autoantibodies
  • Systemic Sclerosis
  • Disease Activity
  • Pulmonary Fibrosis

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