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Clinical Characteristics and Associated Systemic Diseases in Patients With Esophageal “Absent Contractility”—A Clinical Algorithm

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Goals:

This study was carried out to assess the clinical characteristics and associated systemic diseases seen in patients diagnosed with absent contractility as per the Chicago Classification version 3.0, allowing us to propose a diagnostic algorithm for their etiologic testing.

Background:

The Chicago Classification version 3.0 has redefined major and minor esophageal motility disorders using high-resolution esophageal manometry. There is a dearth of publications based on research on absent contractility, which historically has been associated with myopathic processes such as systemic sclerosis (SSc).

Study:

We conducted a retrospective, multicenter study. Data of patients diagnosed with absent contractility were pooled from Cleveland Clinic, Cleveland, OH (January 2006 to July 2016) and Metrohealth Medical Center, Cleveland, OH (July 2014 to July 2016) and included: age, gender, associated medical conditions, surgical history, medications, and specific antibody testing.

Results:

A total of 207 patients, including 57 male individuals and 150 female individuals, with mean age of 56.1 and 60.0 years, respectively, were included. Disease distribution was as follows: SSc (diffuse or limited cutaneous) 132, overlap syndromes 7, systemic lupus erythematosus17, Sjögren syndrome 4, polymyositis 3, and dermatomyositis 3. Various other etiologies including gastroesophageal reflux disease, postradiation esophagitis, neuromuscular disorders, and surgical complications were seen in the remaining cohort.

Conclusions:

Most practitioners use the term “absent contractility” interchangeably with “scleroderma esophagus”; however, only 63% of patients with absent contractility had SSc. Overall, 20% had another systemic autoimmune rheumatologic disease and 16% had a nonrheumatologic etiology for absent contractility. Therefore, alternate diagnosis must be sought in these patients. We propose an algorithm for their etiologic evaluation.
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Keywords: absent contractility; high-resolution esophageal manometry; scleroderma; systemic sclerosis

Document Type: Research Article

Affiliations: 1: Department of Internal Medicine, Cleveland Clinic 2: Digestive Disease Institute, Cleveland Clinic 3: Case Western Reserve University/Lerner College of Medicine, Cleveland Clinic 4: Department of Gastroenterology, MetroHealth Medical Center/Case Western Reserve University, Cleveland, OH 5: Digestive Disease and Surgery Institute, Cleveland Clinic 6: Orthopedic and Rheumatologic Institute, Cleveland Clinic

Publication date: March 1, 2019

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