[Esophageal motility in systemic sclerosis and primary Raynaud' phenomenon by esophageal scintigraphy with semisolid meal]

BACKGROUND: Esophageal transit scintigraphy seems to be a valid methodology to assess impaired esophageal motility, also in the early stages of disease. AIM: To discriminate patients with primary Raynaud's phenomenon (RPh and patients with systemic sclerosis (SSc) from healthy subjects, by esophageal scintigraphy with a semisolid meal. METHODS: Thirty-two patients with primary RPh, 18 patients with SSc and 13 healthy subjects have been studied. Symptoms as dysphagia, acid regurgitation and heartburn, were scored. After an overnight fast, all subjects underwent esophageal scintigraphy, using a semisolid orally ingested bolus (10 ml apple purèe) labelled with 99mTc-sulfur colloid. Esophageal transit and emptying time and integral value were evaluated with the subjects in the upright (sitting) and in the supine position. Transit time was defined as the time from entry of 50% of radioactivity into the upper esophagus, up to the clearance of 50% of the bolus from the whole esophagus. Emptying time was defined as the time from the entry of 50% of radioactivity into the upper esophagus, up to the clearance of 100% of the bolus from the whole esophagus. Integral value was defined as the total count under the time/activity curve normalized to the maximum. RESULTS: Esophageal transit and emptying time, and integral value, evaluated in both positions, were significantly higher in patients with SSc than in healthy subjects and than in patients with RPh. Moreover, patients with RPh had all three parameters, assessed in supine position, significantly longer compared to healthy subjects. Clinical scores regarding dysphagia, acid regurgitation and heartburn were not significantly different between patients with RPh and SSc. CONCLUSIONS: Esophageal transit and emptying time and integral value seem to be able to discriminate well patients with primary RPh from patients with SSc and patients wih RPh from healthy subjects, suggesting an early mild esophageal dysfunction in RPh