Evaluation of esophageal motor functions in patients diagnosed with primary biliary cholangitis, primary sclerosing cholangitis and autoimmune hepatitis

Year 2022, Volume: 47 Issue: 1, 21 - 28, 31.03.2022

Volkan Gökbulut , Ömer Öztürk , Meral Akdoğan Kayhan , Mustafa Kaplan , Sabite Kacar , Hale Sümer Püren Gökbulut , Derya Arı , Dilara Turan Gökçe

https://doi.org/10.17826/cumj.984551

Cited By: 1

Abstract

Purpose: The aim of this study was to evaluate the relationship between autoimmune liver diseases and esophageal motor disorders (EMD).
Materials and Methods: 63 patients diagnosed with primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC) and autoimmune hepatitis (AIH) and followed up in our hospital were included in the study. The control group consisted of 33 patients. Upper gastrointestinal endoscopy, esophageal motility study and pH meter tests were performed on all participants.
Results: Of the 63 patients included in the study 49.2% of the patients, EMD was detected while 31.7% of them had pathology in the pH meter. The rates of EMD of patients with PBC, PSC and AIH were 50%, 63.6%, and 42.9%, respectively while the pathology rates of the pH meter were found as 25%, 54.5%, and 28.6%, respectively. Statistically significant difference was found between autoimmune liver disease and control group in terms of esophageal motor diseases. As a result of manometric examination, median lower esophageal sphincter resting pressure was significantly lower in autoimmune liver patients compared to the control group.
Conclusion: Our study presents that EMD is common in patients with PBC, PSC, and AIH, and that the presence of cirrhosis has no impact on the development of EMD.

Keywords

primary biliary cholangitis, primary sclerosing cholangitis, autoimmune hepatitis, esophageal motility disorder

Primer biliyer kolanjit, primer sklerozan kolanjit ve otoimmün hepatit tanısı alan hastalarda özofagus motor fonksiyonlarının değerlendirilmesi

Abstract

Amaç: Bu çalışmada otoimmün karaciğer hastalıkları ile özofagus motor bozuklukları (EMD) arasındaki ilişkinin incelenmesi amaçlanmıştır.
Gereç ve Yöntem: Çalışmaya Primer biliyer kolanjit (PBC), primer sklerozan kolanjit (PSC) ve otoimmün hepatit (AIH) tanısı konan ve hastanemizde takip edilen 63 hasta dahil edildi. Kontrol grubu 33 hastadan oluşturuldu. Çalışmaya dahil edilen tüm katılımcılara üst gastrointestinal endoskopi, özofagus motilite çalışması ve pH metre testleri yapıldı.
Bulgular: Çalışmaya dahil edilen 63 hastanın %49.2'sinde EMD, %31,7'sinde pH metrede patoloji saptandı. PBC, PSC ve AIH'li hastaların EMD oranları sırasıyla %50, %63.6 ve %42,9 iken pH metrenin patoloji oranları sırasıyla %25, %54.5 ve %28.6 olarak bulundu. Otoimmün karaciğer hastalığı ile kontrol grubu arasında özofagus motor hastalıkları açısından istatistiksel olarak anlamlı fark bulundu Manometrik inceleme sonucunda otoimmün karaciğer hastalarında kontrol grubuna göre alt özofagus sfinkter dinlenme basıncı anlamlı olarak daha düşüktü
Sonuç: Çalışmamız, PBC, PSC ve AIH'li hastalarda EMD'nin yaygın olduğunu ve siroz varlığının EMD gelişimi üzerinde hiçbir etkisi olmadığını ortaya koymaktadır.

Keywords

Primer biliyer kolanjit, primer sklerozan kolanjit, otoimmün hepatit, özofagus motilite bozukluğu

References

• Trivedi PJ, Hirschfield GM. Treatment of autoimmune liver disease: current and future therapeutic options. Ther Adv Chronic Dis. 2013;4:119-41.
• Brahim I, Brahim I, Hazime R, Admou B. Autoimmune hepatitis: immunological diagnosis. Presse Med. 2017;46:1008-19.
• Younossi ZM, Bernstein D, Shiffman ML, Kwo P, Kim WR, Kowdley KV et al. Diagnosis and management of primary biliary cholangitis. Am J Gastroenterol. 2019;114:48-63.
• Dyson JK, Beuers U, Jones DEJ, Lohse AW, Hudson M. Primary sclerosing cholangitis. Lancet. 2018;391:2547-59.
• Sebode M, Weiler-Normann C, Liwinski T, Schramm C. Autoantibodies in autoimmune liver disease-clinical and diagnostic relevance. Front Immunol. 2018;9:609.
• Sucher E, Sucher R, Gradistanac T, Brandacher G, Schneeberger S, Berg T. Autoimmune hepatitis-immunologically triggered liver pathogenesis-diagnostic and therapeutic strategies. J Immunol Res. 2019;2019:9437043.
• Selmi C, Generali E, Gershwin ME. Rheumatic manifestations in autoimmune liver disease. Rheum Dis Clin North Am. 2018;44:65-87.
• John E. Pandolfino, Peter J. Kahrilas, Hogenauer C. Esophageal neuromuscular function and motility disorders. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 11th ed, Feldman M, Friedman LS, Brandt LJ (Eds), Philadelphia. 2020;1692
• Kahrilos PJ, Pandolfino JE. Motility of the esophagus. In: Yamada T, editor. Textbook of Gastroenterology UK: Blackwell publishing. 2009;740-771 B.
• Volter F, FainO, Mathieu E, Thomas M. Esophageal function and Sjögren's syndrome. Dig Dis Sci. 2004;49:248–53.
• Türk T, Pirildar T, Tunç E, Bor S, Doğanavşargil E. Manometric assessment of esophageal motility in patients with primary Sjögren's syndrome. Rheumatol Int. 2005;25:246–9.
• Mandl T, Ekberg O, Wollmer P, Manthorpe R, Jacobsson LT. Dysphagia and dysmotility of the pharynx and oesophagus in patients with primary Sjögren's syndrome. Scand J Rheumatol. 2007;36:394–401.
• Stanghellini V, Chan FK, Hasler WL, Malagelada JR, Suzuki H, Tack J et al. Gastroduodenal disorders. Gastroenterology. 2016;150:1380-92.
• Kahrilos PJ, Pandolfino JE. Motility of the esophagus. In: Yamada T Textbook of Gastroenterology (Ed T Yamada):771-8. London,: Blackwell Publishing. 2009.
• Lleo A, Colapietro F. Changes in the epidemiology of primary biliary cholangitis. Clin Liver Dis. 2018;22:429-441.
• Floreani A, De Martin S, Secchi MF, Cazzagon N. Extrahepatic autoimmunity in autoimmune liver disease. Eur J Intern Med. 2019;59:1-7.
• You BC, Jeong SW, Jang JY, Goo SM, Kim SG, Kim YS et al. Liver cirrhosis due to autoimmune hepatitis combined with systemic sclerosis. Korean J Gastroenterol. 2012;59:48-52.
• Toyoda M, Yokomori H, Kaneko F, Yoshida H, Hoshi K, Takeuchi H et al. Primary biliary cirrhosis-autoimmune hepatitis overlap syndrome concomitant with systemic sclerosis, immune thrombocytopenic purpura. Intern Med. 2009;48:2019-23.
• 19-Richter JE, Wu WC, Johns DN, Blackwell JN, Nelson JL 3rd, Castell JA et al. Esophageal manometry in 95 healthy adult volunteers. Variability of pressures with age and frequency of "abnormal" contractions. Dig Dis Sci. 1987;32:583-92.
• 20. Bektas M, Seven G, Idilman R, Yakut M, Doğanay B, Kabacam G et al. Manometric assessment of esophageal motor function in patients with primary biliary cirrhosis. Eur J Intern Med. 2014;25:230-4.
• 21. Fraile G, Rodríguez-García JL, Moreno A. Primary sclerosing cholangitis associated with systemic sclerosis. Postgrad Med J. 1991;67:189-92.
• 22. Powell A, McNeil J. Primary sclerosing cholangitis associated with CREST (calcinosis, Raynaud phenomenon, oesophageal dysmotility, sclerodactyly and telangiectasia) in an elderly woman: a case report. J Med Case Rep. 2015;9:272.
• 23. Marie I, Levesque H, Tranvouez JL, François A, Riachi G, Cailleux N et al. Autoimmune hepatitis and systemic sclerosis: a new overlap syndrome? Rheumatology (Oxford). 2001;40:102-6.
• 24. Chen SM, Lo GH, Lai KH, Jeng JS, Shen MT, Huang RL et al. Influence of endoscopic variceal ligation on oesophageal motility. J Gastroenterol Hepatol. 1999;14:231-5