전신성 공피증의 식도내압소견 = Manometric Assessment of Esophageal Involvement in Systemic Scleroderma

국문 초록 (Abstract)

저자들은 1989년 9월부터 1990년 8월까지 가톨릭의과대학 부속병원에서 내원한 전신성 공피증 환자에서 식도내압검사를 시행하여 다음 성적을 얻었다.
1) 대상은 American Rheumatism Association(ARA) 기준에 부합되는 전신성공피증환자로 16세부터 68세(평균 39.2세)의 13명(남 1명, 여 12명)이었고 이 중 2명은 CREST 증후군이었다. 대조군은 17세에서 67세(평균 35.7세)로 정상인 10명(남 1명, 여 9명)이었다.
2) 평균 이환기간은 3.5년±3.7년이고 위장관 증상은 연하곤란 23%(3/13), 속쓰림 23%(3/123), 신트림 15%(2/13), 흉통 7%(1/13), 오심 7%(1/13)순이었다. 전신증상은 Raynaud씨 증상(91.7%)과 근염 30%에서 관찰되었다. 모세혈관확장증과 석회침착증은 CREST 증후군환자(2/13)에서만 발견되었다. 심장침범은 8.4%에서 동반되었다.
3) 하부식도괄약근압은 대조군 24±7.24㎜Hg에 비해 공피증환자군은 1071±4.48㎜Hg로 현저히 저하되어 있었다(p＜0.0001).
4) dry swallow시 하부식도수축압은 대조군 43.7±14.7㎜Hg에 비해 공피증환자군은 20.9±23㎜Hg으로 저하되어 있었고(p＜0.005), wet swallow시 하부식도수축압은 대조군 64.1±15.2㎜Hg에 비해 공피증환자군은 30.7±24.9㎜Hg으로 저하되어 있었다(p＜0.005).
5) 공피증환자군에서 정상식도내압검사인 환자는 13명 중 2례였고, 이상소견을 보인 환자 11명 중 연하곤란과 속쓰림 등의 뚜렷한 임상증세를 가진 환자는 3명에 불과하였다.
이상으로 전신성공피증환자에서 식도운동이상을 시고내압검사로 평가하였다. 84%의 공피증환자에서 이상소견이 확인되엇으며, 공피증의 식도침범에서는 식도증상보다 식도내압소견이 이상이 선행하므로 식도내압검사가 공피증의 식도침범에 대한 진단에 예민하고 정확한 검사로 생각된다.

다국어 초록 (Multilingual Abstract)

In systemic scleroderma, serious gastrointestinal involvement is present in approximately 50% of the patients. Management of esophageal manifestation of scleroderma is an important factor in the care of the patients of this disease. In the present study, history and symptoms were assessed using a designed questionnaire. Radiologic examination, echocardiographic examination, and skin biopsy were performed for evaluation of systemic manifestations of scleroderma. Esophageal function was assessed in 13 patients with systemic scleroderma by intraluminal manometry and compared with the results from 10 healthy subjects.
The results were as follows:
1) All patients with systemic scleroderma were diagnosed based on the diagnostic criteria of the American Rheumatism Association (ARA). The mean age of the systemic scleroderma group was 39.2 years (range 16~68 year) and the male-to-female ratio was 1:9.
2) The mean duration of the disease was 3.5 years (rang 0~10 years) in systemic scleroderma patients. The most common symptoms of scleroderma esophagus were heartburn (3/13) and dysphagia (3/13). Other symptoms such as retrosternal pain, belching, and nausea were observed. It is remarkable that 8 out of 11 patients with systemic scleroderma were asymptomatic in spite of manometrically-proven motor abnormalities. Associated systemic manifestations were Raynaud's phenomenon (91.7%), sclerodactyly (91.7%), arthritis (70%), myositis (30%), telangiectasia (15%), calcinosis (15%), and cardiac involvement (8.4%).
3) Lower esophageal pressure was significantly decreased with a mean value of 10.71±4.48㎜Hg compared to the normal controls with 24±7.24㎜Hg (p＜0.0001).
4) Contraction wave amplitudes of the lower esophageal body were decreased in systemic scleroderma with a mean value of 30.7±24.9㎜Hg compared to the normal controls with 64.1±15.2㎜Hg (p＜0.001). Simultaneous contraction was observed in 7 patients of systemic scleroderma.
Esophageal manometric abnormalities were present in four-fifths of the patients with systemic scleroderma. Since there is a great discrepancy between esophageal symptoms and objectively-proven esophageal involvement, manometry should be used in the assessment of patients with systemic scleroderma.