Esophageal dilatation and interstitial lung disease in systemic sclerosis: A cross-sectional study

Abstract

Objective A patulous esophagus on high-resolution computed tomography (HRCT) of the thorax is frequently observed in patients with systemic sclerosis (SSc). Microaspiration has been purported to play a role in the development and progression of SSc interstitial lung disease (ILD), but studies examining the role of microaspiration in SSc ILD have yielded conflicting results. This study was conducted to determine the association between esophageal diameter and SSc ILD. Methods A cross-sectional study of Northwestern Scleroderma Registry patients with available HRCT exams was conducted. The predictor variable was the widest esophageal diameter (WED) on HRCT, and the primary and secondary outcome variables were radiographic ILD and pulmonary function tests respectively. The degree of radiographic ILD was assessed using a semi-quantitative score adapted from published methods. Estimated regression coefficients adjusted for age, sex, race, body mass index, smoking; SSc disease subtype, serum autoantibodies, and disease duration; modified Rodnan skin score, proton pump inhibitor, and immune suppressant medication use and erythrocyte sedimentation rate were calculated. Results A total of 270 subjects were studied. In the adjusted analyses, there were positive associations between WED and total ILD score (β = 0.27; 95% CI: 0.09–0.41), fibrosis (β = 0.15; 95% CI: 0.07–0.23), and ground glass opacities (β = 0.12; 95% CI: 0.04–0.20); there were negative associations between WED and FVC % predicted (β = −0.42; 95% CI: −0.69 to −0.13), and adjusted DLCO % predicted (β = −0.45; 95% CI: − 0.80 to − 0.09) after adjusting for potential confounders. Conclusions Increasing esophageal diameter on HRCT in patients with SSc is associated with more severe radiographic ILD, lower lung volumes, and lower DLCO % predicted. Longitudinal studies are needed to determine if esophageal dilatation is associated with the incidence and/or progression of ILD in patients with SSc.

Oesophageal diameter is associated with severity but not progression of systemic sclerosis‐associated interstitial lung disease

“…Microaspiration secondary to gastro‐oesophageal reflux may contribute to progression of IPF . Cross‐sectional studies have shown that larger oesophageal diameter and worse acid reflux are associated with the presence of radiographic ILD and worse lung function in patients with SSc . A previous study showed that higher bronchoalveolar lavage (BAL) pepsin levels predicted acute exacerbation of IPF, and that BAL pepsin levels were higher during acute exacerbation compared to non‐exacerbated IPF .…”

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

“…The longer AET and bolus clearance time in SSc patients, and lower nocturnal impedance, are likely secondary to esophageal stasis, as supported by the higher frequencies of absent contractility observed on HRM. In fact, results from our center demonstrate that SSc patients have a dilated esophagus on axial chest high‐resolution computed tomography, and that esophageal diameter is positively correlated with radiographic interstitial lung disease (ILD) and negatively correlated with pulmonary function . The controls had higher individual reflux events, which speaks to a different mechanism of reflux in this population.…”

Association of esophageal dilatation in chest CT scan with gastroesophageal reflux disease: A case control study

“…There was no significant difference between esophageal dilation and the grade of esophagitis by covariance analysis (Table s 3 and 4). pime pime pime pime p pi im me e EDITRICE Original Article pose the patient to the recurrent microaspiration and different respiratory complications including lung abscess, asthma and interstitial lung disease (ILD) [1,[20][21][22][23]. Secondly, ED might be correlated with the severity of lung disease or may be a clue for diagnosis of a serious underlying disorder.…”

“…Carrie Richardson et al in a cross-sectional study on 270 cases of systemic sclerosis found that esophageal dilatation on HRCT is correlated with more sever ILD. Affected patients had more sever imaging and functional abnormality including lower lung volume and lower DCLO predicted [21]. Since esophageal motility disorder and TLESR are common in GERD, it is reasonable to see esophageal dilatation with its respiratory complications [24].…”