Tatsuaki Naganawa

OBJECTIVES: To investigate the prevalence of aspiration and its association with GI involvement and clinical features in systemic sclerosis (SSc). METHODS: Fifty patients with SSc who underwent the videofluoroscopic (VF) swallowing study were included. Aspiration was identified by the presence of aspiration and/or penetration defined by the Penetration-Aspiration Scale. The radiological findings including the residue in the oral cavity, pharynx and esophagus, which reflect oral, pharyngeal, and esophageal involvement, were also evaluated. RESULTS: Twenty-three patients (46%) had aspiration and/or penetration. Patients with aspiration and/or laryngeal penetration had more pharyngeal vallecular residue (None 22%, Trace 44%, Mild 56%; p = 0.072) and esophageal residue (None 0%, Mild 20%, Moderate 40%, Severe 61%; p = 0.010). Esophageal, pharyngeal, and lower GI involvement were found in 98%, 83%, and 54%, respectively. Notably, the group with esophageal and pharyngeal plus lower GI involvement had a higher frequency of aspiration and/or penetration (79% vs 28%; p = 0.003), higher FSSG scores (18.4 ± 11.8 vs 5.4 ± 5.7; p = 0.002), and higher UCLA GIT-2.0 total scores (None-to-Mild 47% vs 100%, Moderate 42% vs 0%, Severe-to-Very severe 11% vs 0%; p = 0.001) compared to those limited esophageal and pharyngeal involvement. By multivariate analysis, aspiration and/or penetration was associated with pharyngeal vallecular residue (Odds ratio (OR) 3.71; p = 0.012) and esophageal residue (OR 2.92; p = 0.011), and higher UCLA GIT-2.0 scores for diarrhea (OR 3.68; p = 0.028) and the total score (OR 4.21; p = 0.046). CONCLUSION: In our study, about half of the patients had aspiration and/or penetration in SSc. Aspiration was associated with the extent of radiographic abnormalities of pharyngeal and esophageal involvement on the VF swallowing study. Patients with lower GI have aspiration and high UCLA GIT-2.0 scores suggesting that these patients had more severe GI manifestation.