Original Article
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World J Gastroenterol. Oct 14, 2013; 19(38): 6408-6415
Published online Oct 14, 2013. doi: 10.3748/wjg.v19.i38.6408
Irritable bowel syndrome and organic diseases: A comparative analysis of esophageal motility
Thomas Thomaidis, Martin Goetz, Sebastian Paul Gregor, Arthur Hoffman, Elias Kouroumalis, Markus Moehler, Peter Robert Galle, Andreas Schwarting, Ralf Kiesslich
Thomas Thomaidis, Markus Moehler, Peter Robert Galle, Andreas Schwarting, Medical Clinic, Johannes-Gutenberg University, 55131 Mainz, Rheinland-Pfalz, Germany
Martin Goetz, Medical Clinic, University of Tuebingen, 72076 Tuebingen, Baden-Württemberg, Germany
Sebastian Paul Gregor, Medical Clinic, SHG-Hospital, 55743 Idar-Oberstein, Rheinland-Pfalz, Germany
Arthur Hoffman, Ralf Kiesslich, Medical Clinic, 60318 Frankfurt am Main, Hessen, Germany
Elias Kouroumalis, Clinic of Gastroenterology, Medical School of Crete, 71110 Heraklion, Crete, Greece
Andreas Schwarting, Sana Rheumatology Centre, 55543 Bad Kreuznach, Rheinland-Pfalz, Germany
Author contributions: Thomaidis T, Kouroumalis E and Kiesslich R designed the research; Thomaidis T, Goetz M and Gregor SP performed the research; Galle PR, Schwarting A and Moehler M contributed to the recruitment of patients; Thomaidis T and Kiesslich R analyzed the data; Thomaidis T, Hoffman A and Kiesslich R wrote the paper.
Correspondence to: Thomas Thomaidis, MD, Medical Clinic, Johannes-Gutenberg University, Saarstraße 21, 55131 Mainz, Rheinland-Pfalz, Germany. thomas.thomaidis@unimedizin-mainz.de
Telephone: +49-6131-177146 Fax: +49-6131-173438
Received: December 14, 2012
Revised: March 26, 2013
Accepted: May 9, 2013
Published online: October 14, 2013
Processing time: 305 Days and 7.5 Hours
Abstract

AIM: To assess the esophageal motility in patients with irritable bowel syndrome (IBS) and to compare those with patients with autoimmune disorders.

METHODS: 15 patients with IBS, 22 with systemic lupus erythematosus (SLE) and 19 with systemic sclerosis (SSc) were prospectively selected from a total of 115 patients at a single university centre and esophageal motility was analysed using standard manometry (Mui Scientific PIP-4-8SS). All patients underwent esophago-gastro-duodenoscopy before entering the study so that only patients with normal endoscopic findings were included in the current study. All patients underwent a complete physical, blood biochemistry and urinary examination. The grade of dysphagia was determined for each patient in accordance to the intensity and frequency of the presented esophageal symptoms. Furthermore, disease activity scores (SLEDAI and modified Rodnan score) were obtained for patients with autoimmune diseases. Outcome parameter: A correlation coefficient was calculated between amplitudes, velocity and duration of the peristaltic waves throughout esophagus and patients’ dysphagia for all three groups.

RESULTS: There was no statistical difference in the standard blood biochemistry and urinary analysis in all three groups. Patients with IBS showed similar pathologic dysphagia scores compared to patients with SLE and SSc. The mean value of dysphagia score was in IBS group 7.3, in SLE group 6.73 and in SSc group 7.56 with a P-value > 0.05. However, the manometric patterns were different. IBS patients showed during esophageal manometry peristaltic amplitudes at the proximal part of esophagus greater than 60 mmHg in 46% of the patients, which was significant higher in comparison to the SLE (11.8%) and SSc-Group (0%, P = 0.003). Furthermore, IBS patients showed lower mean resting pressure of the distal esophagus sphincter (Lower esophageal sphincter, 22 mmHg) when compared with SLE (28 mmHg, P = 0.037) and SSc (26 mmHg, P = 0.052). 23.5% of patients with SLE showed amplitudes greater as 160 mmHg in the distal esophagus (IBS and SSc: 0%) whereas 29.4% amplitudes greater as 100 mmHg in the middle one (IBS: 16.7%, SSc: 5.9% respectively, P = 0.006). Patients with SSc demonstrated, as expected, in almost half of the cases reduced peristalsis or even aperistalsis in the lower two thirds of the esophagus. SSc patients demonstrated a negative correlation coefficient between dysphagia score, amplitude and velocity of peristaltic activity at middle and lower esophagus [r = -0.6, P < 0.05].

CONCLUSION: IBS patients have comparable dysphagia-scores as patients with autoimmune disorders. The different manometric patterns might allow differentiating esophageal symptoms based on IBS from other organic diseases.

Keywords: Irritable bowel syndrome; Systemic lupus erythematosus; Systemic sclerosis; Esophageal manometry; Dysphagia

Core tip: This is the first comparative study concerning esophageal motility among functional and autoimmune disorders. Patients in irritable bowel syndrome (IBS)-group showed comparable dysphagia-scores as patients with systemic lupus erythematosus and systemic sclerosis. Nevertheless, different manometric patterns between the three examined groups were observed, which might allow differentiating esophageal symptoms based on IBS from other organic diseases.