Case Control Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2015; 21(7): 2067-2072
Published online Feb 21, 2015. doi: 10.3748/wjg.v21.i7.2067
Increased inspiratory esophagogastric junction pressure in systemic sclerosis: An add-on to antireflux barrier
Miguel Ângelo Nobre e Souza, Patrícia Carvalho Bezerra, Rivianny Arrais Nobre, Esther Studart da Fonseca Holanda, Armênio Aguiar dos Santos
Miguel Ângelo Nobre e Souza, Patrícia Carvalho Bezerra, Rivianny Arrais Nobre, Esther Studart da Fonseca Holanda, Department of Clinical Medicine, Federal University of Ceará, Ceará CEP 60430-040, Brazil
Armênio Aguiar dos Santos, Department of Physiology and Pharmacology, Federal University of Ceará, Ceará CEP 60430-040, Brazil
Author contributions: Nobre e Souza MÂ designed the study, conducted the majority of the experiments, performed the analysis, and wrote the manuscript; Bezerra PC performed the majority of the experiments; Nobre RA performed the majority of the experiments; Holanda ESF performed the majority of the experiments; Santos AA provided financial support for this work and revised the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Miguel Ângelo Nobre e Souza, Professor, Department of Clinical Medicine, Federal University of Ceará, Costa Mendes 1608, 4º andar, Fortaleza, Ceará CEP 60430-040, Brazil. mans@ufc.br
Telephone: +55-85-33668052 Fax: +55-85-33668054
Received: April 22, 2014
Peer-review started: April 23, 2014
First decision: May 29, 2014
Revised: June 20, 2014
Accepted: July 29, 2014
Article in press: July 30, 2014
Published online: February 21, 2015
Processing time: 294 Days and 18.5 Hours
Abstract

AIM: To investigate crural diaphragm (CD) function in systemic sclerosis (SSc) using high-resolution manometry and standardized inspiratory maneuvers.

METHODS: Eight SSc volunteers (average age, 40.1 years; one male) and 13 controls (average age, 32.2 years; six males) participated in the study. A high-resolution manometry/impedance system measured the esophagus and esophagogastric junction (EGJ) pressure profile during swallows and two respiratory maneuvers: sinus arrhythmia maneuver (SAM; the average of six EGJ peak pressures during 5-s deep inhalations) and threshold maneuver (TM; the EGJ peak pressures during forced inhalation under 12 and 24 cmH2O loads). Inspiratory diaphragm lowering (IDL) was taken as the displacement of the EGJ high-pressure zone during the SAM.

RESULTS: SSc patients had lower mean lower esophageal sphincter pressure than controls during normal breathing (19.7 ± 2.8 mmHg vs 32.2 ± 2.7 mmHg, P = 0.007). Sinus arrhythmia maneuver pressure was higher in SSc patients than in controls (142.6 ± 9.4 mmHg vs 104.6 ± 13.8 mmHg, P = 0.019). Sinus arrhythmia maneuver pressure normalized to IDL was also higher in SSc patients than in controls (83.8 ± 13.4 mmHg vs 37.5 ± 6.9 mmHg, P = 0.005). Threshold maneuver pressures normalized to IDL were also greater in SSc patients than in controls (TM 12 cmH2O: 85.1 ± 16.4 mmHg vs 43.9 ± 6.3 mmHg, P = 0.039; TM 24 cmH2O: 85.2 ± 16.4 mmHg vs 46.2 ± 6.6 mmHg, P = 0.065). Inspiratory diaphragm lowering in SSc patients was less than in controls (2.1 ± 0.3 cm vs 3 ± 0.2 cm, P = 0.011).

CONCLUSION: SSc patients had increased inspiratory EGJ pressure. This is an add-on to EGJ pressure and indicates that the antireflux barrier can be trained.

Keywords: Systemic sclerosis; Crural diaphragm; Gastroesophageal reflux; Lower esophageal sphincter

Core tip: Crural diaphragm adaptation in systemic sclerosis may be an add-on to the antireflux barrier. This is an indication that the antireflux barrier can be trained. Our aim was to evaluate crural diaphragm function in systemic sclerosis using high-resolution manometry and standardized inspiratory maneuvers. Systemic sclerosis patients with severe esophageal disease have increased inspiratory esophagogastric junction pressure, despite a low normal-breathing lower esophageal sphincter pressure.