Transabdominal shear-wave elastography for the assessment of esophageal stiffness in systemic sclerosis: a retrospective case-control study.

INTRODUCTION

Gastrointestinal involvement is common in systemic sclerosis (SSc), and distal esophageal fibrosis may develop early, sometimes preceding overt symptoms. Conventional tests such as manometry and endoscopy primarily assess function or mucosal abnormalities and do not quantify tissue stiffness. This study investigated the discriminative ability of transabdominal shear-wave elastography (SWE) for lower esophageal involvement in SSc and its associations with clinical characteristics.

METHODS

In this retrospective case-control study, 37 adult SSc patients with clinically documented lower esophageal involvement and 37 matched healthy controls underwent standardized transabdominal ultrasound and SWE after fasting. Distal esophageal double-wall thickness and stiffness values were measured. Discriminative ability was evaluated using ROC analysis.

RESULTS

Elastography values were significantly higher in SSc patients than in controls (1.41 ± 0.31kPa vs 0.76 ± 0.28kPa; p < 0.001), with good discriminatory performance (AUC = 0.796; p < 0.001). At a 1.25kPa cut-off, sensitivity was 78.4% and specificity 81.1%. Wall thickness did not differ significantly between groups. Higher stiffness was associated with more advanced capillaroscopic patterns, while demographic and serological parameters showed no significant association.

CONCLUSIONS

Transabdominal SWE demonstrates meaningful discriminative ability for detecting lower esophageal involvement in systemic sclerosis. By quantifying tissue stiffness rather than relying solely on morphometric measurements, elastography may capture early fibrotic remodeling before overt structural or functional changes occur. As a non-invasive and reproducible technique, SWE may complement conventional diagnostic tools and support early risk stratification and longitudinal monitoring in SSc. Key Points • Transabdominal shear-wave elastography demonstrated significantly higher lower esophageal stiffness in patients with systemic sclerosis compared to healthy controls. • Elastography may reflect underlying fibrotic remodeling of the esophageal wall as a non-invasive imaging biomarker. • The technique showed good discriminative ability between systemic sclerosis patients and controls. • Findings should be interpreted within a case-control framework, and further studies are needed to establish clinical utility.