Background: Upper gastrointestinal symptoms are commonly experienced in patients with rheumatologic disorders (RD). However, this important aspect is seldom given due importance and rarely investigated in clinical practice. We determined the prevalence of RD amongst patients undergoing high resolution esophageal manometry (HREM) and analysed the symptoms and HREM findings in patients with RD.

Methods: The present study is a retrospective analysis conducted using a prospectively maintained database of patients who underwent HREM between 2012 and 2022. The records were scrutinised to identify patients with RD. The study cohort consisted of patients with RD who were referred for HREM evaluation of upper gastrointestinal symptoms. We excluded patients with incomplete data and those who did not have rheumatologic disorders. The data collected for the study group included age, sex, symptoms, duration of rheumatologic disease, duration of upper gastrointestinal symptoms, endoscopy and HREM findings. The HREM files were reanalysed for all patients using Chicago classification (CC) version 4.0.

Results: A total of 994 HREM studies were conducted during the study period. The study cohort consisted of a total of 32 cases, resulting in a  prevalence of RD among patients undergoing HREM was 3.2%. The majority of the patients were females, and scleroderma was the commonest RD. Regurgitation was the commonest symptom, followed by heartburn. Majority of the cases (28/32, 87.5%) had reflux esophagitis on endoscopy. Ineffective esophageal motility (IEM) was the most common peristaltic disorder, followed by absent contractility (AC). Nearly two-fifths of cases had type 2 or 3 esophagogastric junction. Esophagogastric junction contractile integral (EGJ-CI) was <39.1 mmHg.cm in 26 cases (81.3%). 

Conclusion: Prevalence of RD in patients undergoing HREM is 3.2%. Low EGJ-CI was observed in four-fifths of the patients. IEM and AC are the most common peristaltic abnormalities.