Study links dysphagia in SSc with older age, voice box impairments
Some autoantibodies also were tied to swallowing problems in scleroderma patients
Older age, problems in the larynx, or voice box, and being positive for certain autoantibodies is associated with a higher risk of having dysphagia — difficulty swallowing — in scleroderma patients, according to a single-center study.
Esophageal dysmotility, when foods and liquids do not easily pass down the esophagus, was more common than dysphagia — 68% versus 26%. Xerostomia (dry mouth) was the single risk factor for esophageal dysmotility.
The study, “Clinical Risk Factors for Dysphagia and Esophageal Dysmotility in Systemic Sclerosis,” was published in the Journal of Clinical Medicine.
Patients with scleroderma, also known as systemic sclerosis (SSc), may experience digestive complications as the diseease’s initial symptoms. About 90% of patients show esophageal dysmotility, an abnormal function of the esophagus — the muscular tube that carries food and liquid into the stomach. Dysphagia is another digestive symptom that affects quality of life in these patients.
Despite their high prevalence, few studies have investigated the risk factors for dysphagia and esophageal motility disorders among people with SSc.
Here, researchers at The University of Tokyo Hospital, in Japan, conducted an analysis of data from SSc patients who underwent swallowing tests and examinations of the esophagus from 2010 to 2022. Specifically, the participants underwent X-rays of the esophagus (called esophagography) and an exam to visualize the lining of the esophagus, known as esophagogastroduodenoscopy (ED), Motility of the esophagus was evaluated by videofluoroscopic esophagram, an exam of swallowing.
The researchers then used esophageal dilation scores to assess esophageal dysmotility. In general, the esophagus dilates (widens) when food passes through and contracts after swallowing. But in SSc patients it may remain dilated even after swallowing. Its diameter was assessed after and during swallowing. An ED score 0f three or higher identified patients with esophageal dysmotility.
Videofluoroscopic swallowing study
Dysphagia was evaluated by videofluoroscopic swallowing study (VFSS), an exam that uses X-ray images to evaluate the muscles in the mouth and throat during swallowing. The results were expressed according to a penetration-aspiration scale (PAS), which measures the severity of swallowing dysfunction while swallowing thin liquids. PAS scores (range from 1-8) equal to three or higher were classified as dysphagia.
In total, data from 50 patients (median age 61, 88% females) were analyzed. Almost half (21 patients, 42%) were positive for anti-topoisomerase I autoantibodies (ATAs), followed by 11 patients (22%) with anti-centromere autoantibodies, and nine (18%) with anti-U1 RNP autoantibodies, all characteristic of SSc.
Raynaud’s phenomenon and/or puffy fingers were present in almost all patients.
Overall, 48 patients had taken proton pump inhibitors (PPIs), medications that reduce the amount of stomach acid, and 80% had been treated with immunosuppressants.
Dysphagia was present in 13 patients (26%) and esophageal dysmotility in 34 (68%). ATAs significantly increased the risk of dysphagia by 4.69 times, and anti-U1 RNP autoantibodies by 5.16 times. In contrast, participants with anti-centromere autoantibodies showed a significantly lower risk of developing dysphagia.
Older age and sensory deficits in the larynx were further risk factors for dysphagia. No significant clinical correlation was found between dysphagia and esophageal dysmotility.
Xerostomia was the only identified risk factor for esophageal dysmotility, increasing its likelihood by 9.29 times.
Overall, “esophageal dysmotility was common in SSc and was more frequent than dysphagia,” the researchers wrote, adding that “autoantibodies can be a predictor of dysphagia” and that “dysphagia must be carefully considered in ATAs-positive and elderly patients with SSc.”