Esophagogastric junction in systemic sclerosis: A study with the functional lumen imaging probe

Background Fibrosis and atrophy of esophageal smooth muscle cells cause gastro‐esophageal reflux and dysphagia in most patients with systemic sclerosis ( SS c). Recent studies indicate that distensibility of the esophagogastric junction ( EGJ ), assessed with the Functional Lumen Imaging Probe ( FLIP ) may be a more sensitive and accurate measure of sphincter function than manometry. We aim to describe and compare distension parameters of the EGJ in a well‐characterized group of patients with SS c. Method Twelve patients with SS c reporting reflux or dysphagia (11 women, median age 53 [range 35‐72], duration of disease: 1‐20 years) were investigated using distensibility testing of the EGJ . Patients were compared with 11 healthy volunteers ( HV ) (10 women, median age 53 [range 40‐68]). The pressure and minimum diameter along the EGJ during ramp distension were used for distensibility analysis. Key Results Patients with SS c had significantly lower EGJ yield pressure (median: 4.0 mm Hg [Inter Quartile Range ( IQR ): 2.8‐7.7]) than HV (median: 6.2 mm Hg [ IQR : 9.4‐26]) ( P =.007). Likewise, the pressure‐strain elastic modulus was lower in SS c patients (median 1.73 kP a [ IQR : 1.16‐2.15]) than in HV (median 2.41 kP a [ IQR : 1.85‐2.67]) ( P =.03), indicating the reduced resistance to distension in SS c patient. Conclusion & Inferences Patients with SS c and symptoms of reflux and dysphagia have significantly reduced resistance to distension of the EGJ .