Gastroesophageal Reflux Disease-Related Disorders of Systemic Sclerosis Based on the Analysis of 66 Patients

Abstract

Background/Aims: Gastroesophageal reflux disease (GERD)-related disorders of systemic sclerosis (SSc) patients have not been adequately investigated. Methods: Sixty-six SSc patients (5 males and 61 females; 56.6 ± 14.6 years old) who underwent esophagogastroduodenoscopy were analyzed on the basis of 16 background factors. They were additionally compared with 116 matched non-SSc subjects controlling age, sex, and use of proton pump inhibitors (PPIs). Results: The mean disease duration of 66 patients was 5.1 ± 8.1 years, and their breakdown was as follows: 53 (80.3%) with GERD, 38 (57.6%) with GERD-related symptoms, and 20 (30.3%) with reflux esophagitis (RE; LA-A: 10, LA-B: 5, LA-C: 4, LA-D: 1). Use of PPI (p = 0.0455), complication of interstitial lung disease (p = 0.0242), and history of cyclophosphamide therapy (p = 0.0184) denoted significant association with GERD-related symptoms. Older age (p = 0.0211) was significantly associated with RE. None of GERD-related disorders showed any difference between 37 diffuse cutaneous SSc and 29 limited cutaneous SSc patients. The matched analysis indicated that SSc patients had higher prevalence of GERD (p < 0.0001), GERD-related symptoms (p = 0.0034), and RE (p = 0.0002). Conclusion: SSc patients tend to have worse GERD symptoms and severer RE. However, most SSc-associated factors did not show significant association with GERD-related disorders, indicating the difficulty in predicting GERD-related disorders among SSc patients.

Trends in proton pump inhibitor use, reflux esophagitis, and various upper gastrointestinal symptoms from 2010 to 2019 in Japan

“…As many previous studies have reported [12][13][14], the prevalence of severe reflux esophagitis is low in the Japanese population. Most cases of reflux esophagitis are diagnosed as LA-A or LA-B grades according to the Los Angeles classification [15].…”

Dysphagia, reflux and related sequelae due to altered physiology in scleroderma

“…Concurrent hiatal hernia likely contributes to the occurrence and severity of GERD symptoms in SSc patients. Loss of multiple defense mechanisms against reflux through the various disease processes of SSc may explain why SSc-related GERD is associated with more severe symptoms and more complications[ 51 ].…”

“…If delayed esophageal clearance is noted through diagnostic testing, it should be addressed promptly, as it is likely a major exacerbator of esophageal acidity. Esophageal stasis of acidic contents may contribute to the severity of GERD symptoms and high rate of complications in SSc patients[ 51 ], and should therefore be addressed in therapeutic plans. It is also important to note that esophageal involvement of SSc is linked to development of ILD, a major cause of morbidity and mortality in SSc[ 2 ].…”

“…This likely explains why GERD symptoms are found to be most severe in patients with Gp and other pre-existing conditions, such as SSc[ 3 ]. The complex interplay between Gp and severe GERD may be the reason why patients with SSc are found to have significantly greater reflux symptoms and complications than those with idiopathic reflux[ 51 ]. Correspondingly, treating GERD in patients with SSc may therefore involve treating the underlying Gp.…”

New developments in esophageal function testing and esophageal manifestations of connective tissue disorders

“…95,96 The low esophagogastric junction pressure could cause impaired antireflux barrier function, and impaired peristalsis or decreased salivary secretion could cause prolonged acid clearance. Although there are asymptomatic patients, 97 esophagitis is often seen even on PPI. 98 In addition, Stern et al reported that abnormal esophageal acid exposure despite high-dose PPI therapy was common in patients with SSc.…”