Supplementary Material for: Esophageal hypervigilance and visceral anxiety are involved in esophageal symptom perception in patients with systemic sclerosis

[Background]
Systemic sclerosis (SSc) causes esophageal motility disorders. However, esophageal symptom severity often does not correlate with the physiological findings of high-resolution manometry (HRM) in patients with SSc. Esophageal hypervigilance and visceral anxiety play a relevant role in symptom perception in patients with gastroesophageal reflux disease and esophageal motility disorders. Therefore, the present study examined the effects of anxiety and hypervigilance, along with HRM findings, on esophageal symptom severity in patients with SSc.
[Methods]
We reviewed the clinical data of consecutive patients with SSc who underwent HRM and were assessed using the esophageal hypervigilance and anxiety scale (EHAS) at our hospital between January 2022 and February 2025. Predictors for the Eckardt symptom score (ESS) and gastroesophageal reflux disease questionnaire (GerdQ) were investigated.
[Results]
This study included 51 patients with SSc. Significant differences were observed in EHAS scores between patients with ESS >3 and those with ESS ≤3 (34.0 [24.0-42.0] vs. 13.0 [1.0-24.0], p=0.003), but not in HRM findings. The EHAS score accounted for 38.2% of variance in the ESS score. Significant differences were also observed in the EHAS score between patients with GerdQ ≥8 and those with GerdQ <8 (26.0 [14.3-32.5] vs. 13.0 [0-22.0], p=0.011). The combined factors of the EHAS score and absent contractility accounted for 17.3% of variance in the GerdQ score.
[Conclusion]
Esophageal hypervigilance and anxiety may be involved in esophageal symptom severity, particularly dysphagia severity, in patients with SSc. Further studies involving interventions targeting these conditions, such as cognitive behavioral therapy, are warranted.

【背景】系统性硬化症（Systemic sclerosis, SSc）可引发食管运动障碍。然而，SSc患者的食管症状严重程度往往与高分辨率食管测压（high-resolution manometry, HRM）的生理检查结果并无相关性。食管高警觉性与内脏焦虑在胃食管反流病（gastroesophageal reflux disease）及食管运动障碍患者的症状感知中发挥着重要作用。因此，本研究旨在探讨焦虑、食管高警觉性联合HRM检查结果对SSc患者食管症状严重程度的影响。
【方法】本研究回顾性分析了2022年1月至2025年2月期间于我院接受HRM检查且采用食管高警觉与焦虑量表（esophageal hypervigilance and anxiety scale, EHAS）进行评估的连续纳入SSc患者的临床资料，并对埃克特症状评分（Eckardt symptom score, ESS）与胃食管反流病问卷（gastroesophageal reflux disease questionnaire, GerdQ）的预测因素进行了分析。
【结果】本研究共纳入51例SSc患者。埃克特症状评分（ESS）＞3分与≤3分的患者组间EHAS评分差异具有统计学意义[34.0（24.0~42.0）vs. 13.0（1.0~24.0），P=0.003]，而HRM检查结果则无组间差异。EHAS评分可解释ESS评分38.2%的变异度。胃食管反流病问卷（GerdQ）≥8分与＜8分的患者组间EHAS评分同样存在显著统计学差异[26.0（14.3~32.5）vs. 13.0（0~22.0），P=0.011]。EHAS评分与食管收缩缺失的联合因素可解释GerdQ评分17.3%的变异度。
【结论】食管高警觉性与焦虑可能与SSc患者的食管症状严重程度相关，尤其是吞咽困难严重程度。未来需开展针对此类干预措施（如认知行为疗法（cognitive behavioral therapy））的相关研究。