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Scintigraphic Detection of Metaclopramide Esophageal Stimulation in Progressive Systemic Sclerosis

Divisions of Nuclear Medicine, Gastroenterology, and Rheumatology, Department of Radiology, Naval Hospital, Bethesda
Uniformed Services University for the Health Sciences, Bethesda, Maryland

Correspondence: For reprints contact: Walter E. Drane, MD, Div. of Nuclear Medicine, NHBethesda, NMCNCR, Bethesda, MD 20814.

ABSTRACT

Supine radionuclide esophageal scintigraphy (RES) and manometry were used to prospectively evaluate metaclopramide effect on esophageal function and pressure amplitudes in 14 patients (12 females and two males; median time since diagnosis: 2 yr) with progressive systemic sclerosis (PSS). Quantitation of RES included calculation of percent emptying at 30 sec, and standard manometric measurements were obtained. RES and manometry were performed before and 10 min following the i.v. administration of metaclopramide. RES showed a significant increase in mean percent emptying from 36% to 46% after drug administration (p < 0.01), while mean tower esophageal pressure (end-expiratory) increased from 2 to 11 mm of Hg (p < 0.001). Manometry failed to reveal a significant increase in either distal or proximal mean esophageal contractile amplitude, and no correlation was found between the increase in percent emptying at RES and the change in lower esophogeal pressure in the individual patient. RES is the only quantitative method presently available to evaluate bolus propagation in the esophagus, and it documented improved esophageal function after metaclopramide administration in a PSS population. When drug therapy is directed at augmentation of esophageal emptying, RES is an ideal method to evaluate drug response.