Anam Qureshi, MD1, Asad Jehangir, MD2, Zubair Malik, MD2, Henry P. Parkman, MD, FACG2; 1Reading Hospital - Tower Health, Reading, PA; 2Temple University Hospital, Philadelphia, PA
Introduction: Rheumatological disorders (RD) can have gastrointestinal (GI) manifestations. Patients with systemic sclerosis (SSc) often have upper GI symptoms from absent contractility (AC) of the esophagus. Upper GI symptom characteristics and high-resolution esophageal manometry with impedance (HREMI) findings of other RD have not been well studied. We aimed to: 1) Determine the prevalence of RD in patients undergoing HREMI. 2) Assess the symptom characteristics and manometric findings of these patients. Methods: Patients undergoing HREMI from 7/2018 to 3/2020 were studied. Patients rated the severity of their GI symptoms on a modified Patient Assessment of Upper GI Symptoms (PAGI-SYM) and reported their past medical history. Healthy volunteers (HVs) also underwent HREMI. Results: Of 1003 patients undergoing HREMI, 90 (9%) had RD (mean age 55.3±1.4 years, 73.3% females), most commonly SSc (n=27), rheumatoid arthritis (RA, n=20), and systemic lupus erythematosus (SLE, n=11, Table 1). The most severe upper GI symptoms in patients with RD were heartburn, regurgitation, nausea, and dysphagia. There were no significant differences in the severities of upper GI symptoms between patients with SSc, RA and SLE (Table 2). Half (51.1%) of the RD patients reported Raynaud’s phenomenon (RP). Patients with SLE (72.7%) and SSc (66.7%) more commonly had RP than RA patients (35%, p=0.04). Compared to 20 HVs (mean age 31.9±2.4 years, 30% females), the RD patients had higher upper esophageal sphincter (UES) mean peak (p=0.03) and residual pressures (p=0.01), lower distal contractile integral (DCI, p=0.04), lower bolus clearance (p< 0.01), and more frequent hiatal hernia (HH, p< 0.01) on HREMI. Over half (n=55, 61.1%) of patients with RD had esophageal motility disorders, most commonly AC (n=25), ineffective esophageal motility (IEM; n=18), and esophagogastric outflow obstruction (EGJOO) disorders (EGJOO=7, type III achalasia=2, type I achalasia=1, type II achalasia=1). Discussion: Amongst patients undergoing HREMI, 9% had history of RD, most commonly SSc, RA and SLE. The most severe upper GI symptoms were heartburn, regurgitation, nausea, and dysphagia. Upper GI symptom severities did not distinguish different RD. Patients with RD had higher UES pressures, weaker DCI, lower bolus clearance, and more frequent HH on HREMI than HVs. Although AC and IEM were most common motility disorders, a considerable minority (11.1%) of our RD patients had EGJOO disorders.
Disclosures: Anam Qureshi indicated no relevant financial relationships. Asad Jehangir indicated no relevant financial relationships. Zubair Malik indicated no relevant financial relationships. Henry Parkman indicated no relevant financial relationships.