Abnormal esophageal acid exposure on high‐dose proton pump inhibitor therapy is common in systemic sclerosis patients

Abstract

Abnormal esophageal acid exposure despite high-dose PPI therapy was common among patients with SSc. The lack of increased reflux episodes in the SSc patients, and longer bolus clearance times and lower nocturnal impedance, supports ineffective clearance as the potential mechanism. Systemic sclerosis patients may require adjunctive therapies to PPIs to control acid reflux.

Gastrointestinal manifestations of systemic sclerosis: An updated review

“…A PPI daily dose is started 30-60 min before the first meal of the day, and the dose is increased to twice daily if the response is partial or there are nocturnal symptoms[ 55 ]. A matched retrospective case-control study in which 38 patients with SSc and 38 controls who underwent esophageal pH-impedance with double-dose PPI were included found a higher AET ≥ 4.5% (61% cases vs 18% controls P < 0.001), higher median bolus clearance, and lower mean nocturnal baseline impedance, which would support ineffective esophageal clearance as the potential mechanism, for which additional therapies with PPIs to control acid reflux should be considered in these patients[ 56 ]. A clinical trial that included SSc patients with GERD who had a partial response to PPIs randomized to domperidone and alginic acid found that after treatment with both drugs, the severity and frequency of symptoms and quality of life improved; however, 17% of the patients did not respond to the combination treatment[ 57 ].…”

Personalized Approach to the Management of GERD: GI Perspective

“…6,7 Suspicion of GERD may be further heightened in the presence of other co-morbid conditions which can augment reflux physiology such as a hiatal hernia, central obesity, or connective tissue disorders (ie, scleroderma). [8][9][10][11] Further, initial evaluations should assess for symptom specific anxiety, psychological comorbidity and hypervigilance, as well as the potential of non-GERD disorders, such as rumination, a belching disorder, eosinophilic esophagitis, or achalasia.…”

How to select patients for antireflux surgery? The ICARUS guidelines (international consensus regarding preoperative examinations and clinical characteristics assessment to select adult patients for antireflux surgery)

“…81 86 Although the oesophagus is not always affected in patients with systemic sclerosis, the majority of patients with oesophageal involvement is found to have aperistalsis, which is a risk factor for postoperative dysphagia also in patients without scleroderma. [87][88][89] 8. Patients with concomitant functional disorders such as dyspepsia and IBS are good candidates for antireflux surgery, only if symptoms can be attributed to reflux.…”