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AIM:To investigate crural diaphragm(CD)function in systemic sclerosis(SSc)using high-resolution manometryand standardized inspiratory maneuvers.METHODS:Eight SSc volunteers(average age,40.1years;one male)and 13 controls(average age,32.2years;six males)participated in the study.A highresolution manometry/impedance system measured the esophagus and esophagogastric junction(EGJ)pressure profile during swallows and two respiratory maneuvers:sinus arrhythmia maneuver(SAM;the average of six EGJ peak pressures during 5-s deep inhalations)and threshold maneuver(TM;the EGJ peak pressures during forced inhalation under 12 and 24 cm H2O loads).Inspiratory diaphragm lowering(IDL)was taken as the displacement of the EGJ high-pressure zone during the SAM.RESULTS:SSc patients had lower mean lower esophageal sphincter pressure than controls during normal breathing(19.7±2.8 mm Hg vs 32.2±2.7 mm Hg,P=0.007).Sinus arrhythmia maneuver pressure was higher in SSc patients than in controls(142.6±9.4 mm Hg vs 104.6±13.8 mm Hg,P=0.019).Sinus arrhythmia maneuver pressure normalized to IDL was also higher in SSc patients than in controls(83.8±13.4 mm Hg vs37.5±6.9 mm Hg,P=0.005).Threshold maneuver pressures normalized to IDL were also greater in SSc patients than in controls(TM 12 cm H2O:85.1±16.4mm Hg vs 43.9±6.3 mm Hg,P=0.039;TM 24 cm H2O:85.2±16.4 mm Hg vs 46.2±6.6 mm Hg,P=0.065).Inspiratory diaphragm lowering in SSc patients was less than in controls(2.1±0.3 cm vs 3±0.2 cm,P=0.011).CONCLUSION:SSc patients had increased inspiratory EGJ pressure.This is an add-on to EGJ pressure and indicates that the antireflux barrier can be trained.
AIM: To investigate the ability of the crural diaphragm (CD) function in systemic sclerosis (SSc) using high-resolution manometry and standardized inspiratory maneuvers. METHODS: Eight SS volunteers (average age, 40.1 years; one male) and 13 controls (average age, 32.2 years; six males) participated in the study. A highresolution manometry / impedance system measured the esophagus and esophagogastric junction (EGJ) pressure profile during swallows and two respiratory maneuvers: sinus arrhythmia maneuver (SAM; the average of six EGJ peak pressures during 5-s deep inhalations) and threshold maneuver (TM; the EGJ peak degrees during forced inhalation under 12 and 24 cm H2O loads) .Inspiratory diaphragm lowering (IDL) was taken as the displacement of the EGJ high-pressure zone during the SAM .RESULTS: SSc patients had lower mean lower esophageal sphincter pressure than controls during normal breathing (19.7 ± 2.8 mm Hg vs. 32.2 ± 2.7 mm Hg, P = 0.007) .Sinus arrhythmia maneuver pressure was higher in SSc patients than in controls (142.6 ± 9.4 mm Hg vs 104.6 ± 13.8 mm Hg, P = 0.019) .Sinus arrhythmia maneuver pressure normalized to IDL was also higher in SSc patients than in controls (83.8 ± 13.4 mm Hg vs 37.5 ± 6.9 mm Hg, P = 0.005) .Threshold maneuvers normalized to IDL were also greater in SSc patients than in controls (TM 12 cm H2O: 85.1 ± 16.4 mm Hg vs 43.9 ± 6.3 mm Hg, P = 0.039; TM 24 cm H2O: 85.2 ± 16.4 mm Hg vs 46.2 ± 6.6 mm Hg , P = 0.065) .Inspiratory size lowering in SSc patients was less than in controls (2.1 ± 0.3 cm vs 3 ± 0.2 cm, P = 0.011) .CONCLUSION: SSc patients had increased inspiratory EGJ pressure. This is an add-on to EGJ pressure and indicates that the antireflux barrier can be trained.