pdf

Prevalence of esophageal abnormalities detected in
contrasted image of the esophagus in systemic sclerosis
and profile of associated autoantibodies
Poster No.:
C-0562
Congress:
ECR 2014
Type:
Scientific Exhibit
Authors:
A. K. Sakuma , A. Amaral e Castro , T. Larocca Skare , W. Haese
1
2
2
2
2
2 1
2
Barros , R. Lírio Bortoncello , F. Morandini ; Paris/FR, Curitiba/
BR
Keywords:
Swallowing disorders, Obstruction / Occlusion, Epidemiology,
Statistics, Laboratory tests, Barium meal, Conventional
radiography, Thorax, Mediastinum, Gastrointestinal tract
DOI:
10.1594/ecr2014/C-0562
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Page 1 of 19
Aims and objectives
Introduction
Systemic sclerosis (SS) is an idiopathic multisystem disease characterized by an
abnomality of small blood vessels, skin and visceral fibrosis. There are specific diagnostic
criteria for this condition, as well as classification criteria for activity and severity. The socalled CREST syndrome (calcinosis, Raynaud, esophagus, sclerodactyly, telangiectasia)
can lead to esophageal abnomalities with significant morbidity for the affected patient
[1,2].
Fig. 1: CREST syndrome
References: Department of Rheumathology, Hospital Universitário Evangélico de
Curitiba/ Brazil 2013
The esophagus is the most affected region of the gastrointestinal tract in SS. Its
pathogenesis is not yet fully understood, although it is recognized atrophy, fibrosis and
obliteration of vascularization and innervation of the muscles of the body, resulting in
dyskinesia of its body, associated perhaps, with lower esophageal sphincter dysfunction.
The SS is the prototype disorder of esophageal dyskinesia. Manometric evidence
of organ dysfunction can be found in about 80% of affected patients. The desease
characteristically affects the smooth muscle of the distal esophagus, although in some
cases the proximal skeletal muscles may be involved [1,3,4].
Page 2 of 19
Page 3 of 19
Fig. 2: Double contrast barium study, showing a significant esophageal dilatation.
References: Department of Radiology, Hospital Universitário Evangélico de Curitiba/
Brazil 2013
The decreased peristalsis of the distal esophagus and their possible association with
gastroesophageal reflux (GER), delays esophageal clearance, allowing a prolonged
exposure to refluxed liquid, possibly resulting in severe esophagitis and other deseases
related to GER. The treatment of these specific conditions, without compromising organ
function, is important. For example, there is the video laparoscopic [5] anti- reflux surgery.
Page 4 of 19
Fig. 3: Double contrast barium study, showing distal esophageal dilatation and signs
of esophagitis.
References: Department of Radiology, Hospital Universitário Evangélico de Curitiba/
Brazil 2013
It is estimated that 80% or more of patients with SS have some detectable autoantibody.
These autoantibodies may provide information regarding the diagnosis of the disease.
Page 5 of 19
Moreover, many of them are related to clinical characteristics of each patient , including
esophagic changes [6,7,8].
Esophageal manometry is the gold standard test for the diagnosis of esophageal motor
disorders, while endoscopy is used to study the changes of the mucosa, related to the
GER [1].
As for imaging, today there is a large focus toward the CT scans and MRIs. Despite
this, the barium examination remains the primary modality for radiological evaluation
of patients with dysphagia, GER and other clinical findings of esophageal diseases.
Esophagographies with double contrast are particularly useful for the detection of GER
and its complications. Fluoroscopy, part of these routine examinations, is very useful
to study the motility of the esophagus and detecting related disorders. Radiographic
findings in the SS esophagography may include weak or absent peristalsis in the
distal esophagus, delayed esophageal emptying, rigid dilated esophagus that does not
colapses while emptying, and GER [9].
Barium x-ray examinations like the esophagographies and esophagogastroduodenal
seriographies, are exams with undeniable importance in the study of anatomy and upper
gastrointestinal diseases, as well as being a group of tests considered as cheap, quick,
simple and with minimal risk to the patient [10].
The primary diagnostic approach of patients with SS with or without esophageal
symptoms can be taken with esophagogastroduodenal seriographies.
The present study analyses the prevalence of esophageal abnormalities in patients
with SS evidenced by esophagogastroduodenal seriography with esophageal symptoms,
comparing them with patients without esophageal symptoms. It also compares the clinical
and autoantibodies profile of both groups.
Images for this section:
Page 6 of 19
Fig. 1: CREST syndrome
Page 7 of 19
Page 8 of 19
Fig. 2: Double contrast barium study, showing a significant esophageal dilatation.
Fig. 3: Double contrast barium study, showing distal esophageal dilatation and signs of
esophagitis.
Page 9 of 19
Methods and materials
31 patients with sclerodermia, according to the Preliminary qualifying Criteria of the
American College of Rheumatology, were included. It was collected data about signs and
symptoms of the sclerodermia through medical records review. Moreover, it was applied
the International dysphagia specific questionary and taken the seriography, following the
institution`s exam protocol. Significance level for statistic analysis was 0,05.
Results
31 patients were studied. 90,7% females and 80,6% caucasians, with average age of
50 years. The main clinical type was limited form (64,5%). The main clinical finding was
Raynaud`s phenomenon (96%).
Table 1: Clinical findings
References: Department of Rheumathology, Hospital Universitário Evangélico de
Curitiba/ Brazil 2013
NAF was positive in 93% of the patients and the most prevalent autoantibody was the
anticentromere (34,6%).
Page 10 of 19
Table 2: Autoantibodies profile
References: Department of Rheumathology, Hospital Universitário Evangélico de
Curitiba/ Brazil 2013
80% of the patients shown at least one alteration on the esophagogastroduodenal
seriography, being the esophageal caliber variation, the most usual (54%).
Table 3: Alterations on esophagogastroduodenal seriography
References: Department of Rheumathology, Hospital Universitário Evangélico de
Curitiba/ Brazil 2013
Page 11 of 19
Page 12 of 19
Fig. 4: Alteration on the esophageal caliber
References: Department of Radiology, Hospital Universitário Evangélico de Curitiba/
Brazil 2013
No significant difference between both groups was found, as symptoms comparison,
dysphagia questionary points, seriography results and laboratory profile are concerned.
Images for this section:
Table 1: Clinical findings
Table 2: Autoantibodies profile
Page 13 of 19
Table 3: Alterations on esophagogastroduodenal seriography
Page 14 of 19
Page 15 of 19
Fig. 4: Alteration on the esophageal caliber
Page 16 of 19
Conclusion
No significant differences in clinical or laboratorial profile was found. Neither in the
dysphagia questionary points or in the alterations in the seriography exam for both
groups.
Personal information
Alexandre Sakuma, Student.
Department of Radiology, Faculty of Medicine, Faculdade Evangélica do Paraná,
Curitiba, Brazil;
[email protected]
Adham do Amaral e Castro, M.D.
Department of Radiology, Hospital Universitário Evangélico de Curitiba, Curitiba, Brazil;
[email protected]
Thelma Larocca Skare, M.D., Ph.D.
Department of Rheumatology, Hospital Universitário Evangélico de Curitiba, Curitiba,
Brazil;
Wagner Haese Barros, M.D.
Department of Radiology, Hospital Universitário Evangélico de Curitiba, Curitiba, Brazil;
Rafael Lírio Bortoncello, M.D.
Department of Radiology, Hospital Universitário Evangélico de Curitiba, Curitiba, Brazil;
Fernando Morandini, M.D.
Department of Radiology, Hospital Universitário Evangélico de Curitiba, Curitiba, Brazil;
Page 17 of 19
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