Omeprazole in the long‐term treatment of severe gastro‐oesophageal reflux disease in patients with systemic sclerosis

Hendel, L.; Häge, Esther; Hendel, Jakob; Stentoft, P.

doi:10.1111/j.1365-2036.1992.tb00571.x

Cited by 73 publications

(35 citation statements)

References 19 publications

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“…Hendel and colleagues reported that complete healing of oesophagitis was achieved in less than a half of patients with advanced SSc treated with omeprazole [27]. In contrast, we could show in our patients with early SSc that adequate PPI therapy and elimination of Hp led to complete mucosal healing in the distal oesophagus and stomach.…”

Section: Discussioncontrasting

confidence: 76%

Early endoscopy in systemic sclerosis without gastrointestinal symptoms

Thonhofer

Siegel²,

Trummer³

et al. 2010

Rheumatol Int

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Investigation into the upper GI-tract of patients suffering from systemic sclerosis [SSc] and mixed connective tissue disease [MCTD] without symptoms of GI-tract involvement early in the course of the disease to diagnose inflammatory and motility disorders. We retrospectively analysed patients with SSc and MCTD who underwent oesophago-gastro-duodenoscopy [OGD] within a year of the first diagnosis. Patients with a Rodnan skin score above 5, proton pump inhibitors and treatment regimes potentially harmful to the mucosa of the upper GI-tract were excluded. Mucosal damage of the oesophagus was classified according to the Los Angeles Classification. Oesophageal dysmotility was assessed during OGD and confirmed by video cineradiography. A total of thirteen patients with SSc and six with MCTD fulfilled the inclusion criteria. OGD revealed reflux-oesophagitis in 77%, dysmotility of the distal oesophagus in 85%, gastritis in 92% [31% erosive gastritis] and Helicobacter pylori positivity in 38% of our patients suffering from SSc. Patients with MCTD showed features of reflux-oesophagitis, dysmotility of the distal oesophagus, gastritis and dysmotility of the stomach in 0.6%. In all thirteen patients with SSc, significant pathology of the upper GI-tract was found. The results of this study might indicate that OGD should be performed early in patients diagnosed with SSc, even if they do not report typical symptoms. An early diagnose of GI involvement might be followed by an effective therapy and therefore subsequently may improve the prognosis.

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Section: Discussioncontrasting

confidence: 76%

Early endoscopy in systemic sclerosis without gastrointestinal symptoms

Thonhofer

Siegel²,

Trummer³

et al. 2010

Rheumatol Int

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“…18 Even adding ranitidine at night to omeprazole does not improve nocturnal acid breakthrough and quality of life in these patients. 19 -Data from impedance studies show that treatment with acid reducing medications only affects acid production and raises the pH of the gastric refluxate, but reflux still occurs as the frequency and duration of reflux episodes is not affected.…”

Section: Connective Tissue Disorders and Esophageal Motilitymentioning

confidence: 99%

“…17 Therapeutic Implications Proton pump inhibitors have been the main form of treatment for GERD in patients with CTD, while surgery has been rarely considered. 18,19 This approach stems from the belief that peristalsis is absent in most patients with CTD so that a fundoplication must be avoided for fear of creating or worsening dysphagia. This mind-set has several pitfalls because of the following reasons:…”

Section: Connective Tissue Disorders and Esophageal Motilitymentioning

confidence: 99%

Gastroesophageal Reflux Disease and Connective Tissue Disorders: Pathophysiology and Implications for Treatment

Patti

Gasper

Fisichella

et al. 2008

Journal of Gastrointestinal Surgery

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These data show that esophageal motor function is preserved in most patients with CTD, so that they should be offered antireflux surgery early in the course of their disease to prevent esophageal and respiratory complications. In patients with ESLD in whom peristalsis is absent, a partial rather than a total fundoplication should be performed, as it allows control of reflux symptoms while avoiding postoperative dysphagia.

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“…Based on the underlying esophageal motor dysfunction, gastroesophageal reflux with its potential complication is the most important clinical manifestation of gastrointestinal involvement in systemic sclerosis. Many patients require more intensive medical therapy to control symptoms and/or heal mucosal disease [31][32][33]. Generally, this treatment should rely on proton pump inhibitors as the most effective acid suppressive medication.…”

Section: Esophageal Manifestationsmentioning

confidence: 99%

Gastrointestinal Manifestations of Systemic Sclerosis

2007

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Systemic sclerosis is a chronic disorder of connective tissue that affects the gastrointestinal tract in more than 80% of patients. Changes in neuromuscular function with progressive fibrosis of smooth muscle within the muscularis propria impair normal motor function, which may secondarily alter transit and nutrient absorption. Esophageal manifestations with gastroesophageal reflux and dysphagia are the most common visceral manifestation of the disease, often requiring more intense acid-suppressive medication. Gastric involvement may lead to gastroparesis, which can be found in up to 50% of patients. Severe small bowel disease can present as chronic intestinal pseudo-obstruction with distended loops of small intestine, bacterial overgrowth, impaired absorption and progressive development of nutritional deficiencies. While not studied as extensively, systemic sclerosis often also affects colorectal function resulting in constipation, diarrhea or fecal incontinence. Nutritional support and prokinetics have been used with some success to manage gastric and small or large bowel involvement in patients with systemic sclerosis. Despite advances in management, significant gastrointestinal manifestations of systemic sclerosis still carry a poor prognosis with a five-year mortality exceeding 50%.

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Omeprazole in the long‐term treatment of severe gastro‐oesophageal reflux disease in patients with systemic sclerosis

Cited by 73 publications

References 19 publications

Early endoscopy in systemic sclerosis without gastrointestinal symptoms

Early endoscopy in systemic sclerosis without gastrointestinal symptoms

Gastroesophageal Reflux Disease and Connective Tissue Disorders: Pathophysiology and Implications for Treatment

Gastrointestinal Manifestations of Systemic Sclerosis

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