Oesophageal and anorectal involvement in systemic sclerosis: a systematic assessment high resolution manometry

Objective. In systemic sclerosis (SSc), oesophageal and anorectal involvements are frequent and often associated with each other. In clinical practice, oesophageal explorations are often prescribed, while anorectal explorations are rarely proposed and therefore, under-recognised. However, it is well documented in the literature that early detection of anorectal dysfunction could delay and/or prevent the onset of symptoms such as fecal incontinence (FI). The main objective was the systematic evaluation and detection of oesophageal and anorectal involvements in SSc patients. Methods. In this monocentric retrospective study, all patients with SSc addressed in the Department of Functional Digestive Explorations, North Hospital, Marseille for oesophageal and anorectal explorations were included. Self-Questionnaires, evaluating the symptoms and quality of life, were filled by patients during their visit. Explorations were performed on the same day: high resolution oesophageal manometry (EHRM), 3 Dimensional high resolution anorectal manometry (3DHRARM) and endo anal sonography (EUS). Results. 44 patients (41 women), mean age 59.8 +/- 12 years, were included. With regard to the symptoms, 45.5% of patients had gastro-oesophageal reflux disease (GERD), 66.9% dysphagia, 65.9% constipation and 773% Fl. The incidence of oesophageal dismotility was 65.9%, anorectal and both upper and lower dysfunction were 43.2%. More than 89% patients with abnormal explorations (EHRM, 3DHRARM or both) were symptomatic. Duration of SSc and altered quality of life was correlated with the severity of digestive involvement. Conclusion. Anorectal dysfunction appears to be closely linked to oesophageal involvement in SSc. Their routine screening is undoubtedly essential to limit the occurrence of severe symptoms such as FI.