Clinical and endoscopic signs of esophageal involvement in patients with systemic sclerosis

Esophageal involvement is one of the most frequent visceral manifestations of systemic sclerosis (SSc), however, its association with the course of the disease has been insufficiently studied. Endoscopy is considered the most accessible instrumental method for examining the esophagogastroduodenal zone, and in combination with clinical symptoms forms the basis for diagnosing esophageal diseases.

Objective: to investigate the frequency of clinical and endoscopic signs of esophageal disorders (ED) and their association with clinical manifestations of SSc.

Material and methods. A total of 81 patients with SSc hospitalized at the Chelyabinsk Regional Clinical Hospital from December 2019 to September 2024 were examined.

Results and discussion. In 40 (49.4%) patients, symptoms characteristic of ED were present: dysphagia (n=38, 46.9%) and heartburn (n=14, 17.3%). During esophagogastroduodenoscopy, erosive esophagitis (EE) was detected in 13 (16%) patients. In 5 (6.2%) cases, esophagitis grade B or higher was identified, and in 2 (2.5%) – grade D. Patients with EE more frequently had digital ulcers and scars, and treatment included sildenafil and cyclophosphamide (CYP) (p<0.05). The frequency of esophageal erosions was 4.12 times higher in the presence of digital ulcers (95% confidence interval, CI 1.20–14.13; p<0.05) and 9.48 times higher with CYP use (95% CI 1.81–49.45). The frequency of interstitial lung disease (ILD) did not depend on the presence of EE, but increased 4.33 times in the presence of esophageal atony according to radiography (95% CI 1.24–15.2).

Conclusion. Patients with SSc report dysphagia or heartburn in half of the cases. EE is associated with more pronounced microcirculatory disturbances and treatment with CYP. ILD occurred more frequently when radiologic signs of esophageal atony were present.

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