title: Gastroesophageal reflux and pulmonary fibrosis in scleroderma: a study using pH-impedance monitoring.
abstract: BACKGROUND
  Interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) is associated with increased morbidity and mortality. Gastroesophageal reflux (GER) is considered a contributing factor in the pathogenesis of ILD.
  
  
  OBJECTIVE
  To characterize GER (acid and nonacid) in patients with SSc with and without ILD.
  
  
  METHODS
  Patients with SSc underwent pulmonary high-resolution computer tomography (HRCT) scan and 24-hour impedance-pH monitoring off-proton pump inhibitor therapy. The presence of pulmonary fibrosis was assessed using validated HRCT-scores. Reflux monitoring parameters included number of acid and nonacid reflux episodes, proximal migration of the refluxate, and distal esophageal acid exposure. Unless otherwise specified, data are presented as median (25th-75th percentile).
  
  
  RESULTS
  Forty consecutive patients with SSc (35 female; mean age, 53 yr; range, 24-71; 15 patients with diffuse and 25 with limited SSc) were investigated; 18 (45%) patients with SSc had pulmonary fibrosis (HRCT score >or= 7). Patients with SSc with ILD had higher (P < 0.01) esophageal acid exposure (10.3 [7.5-15] vs. 5.2 [1.5-11]), higher (P < 0.01) number of acid (41 [31-58] vs. 19 [10-23]) and nonacid (25 [20-35] vs. 17 [11-19]) reflux episodes, and higher (P < 0.01) number of reflux episodes reaching the proximal esophagus (42.5 [31-54] vs. 15 [8-22]) compared with patients with SSc with normal HRCT scores. Pulmonary fibrosis scores (HRCT score) correlated well with the number of reflux episodes in the distal (r(2) = 0.637) and proximal (r(2) = 0.644) esophagus.
  
  
  CONCLUSIONS
  Patients with SSc with ILD have more severe reflux (i.e., more reflux episodes and more reflux reaching the proximal esophagus). Whether or not the development of ILD in patients with SSc can be prevented by reflux-reducing treatments needs to be investigated.
authors.affiliation: Division of Gastroenterology, University of Genoa, Genoa, Italy. edoardo.savarino@unige.it
authors.forename: Edoardo
authors.initials: E
authors.lastname: Savarino
authors.forename: Marco
authors.initials: M
authors.lastname: Bazzica
authors.forename: Patrizia
authors.initials: P
authors.lastname: Zentilin
authors.forename: Daniel
authors.initials: D
authors.lastname: Pohl
authors.forename: Andrea
authors.initials: A
authors.lastname: Parodi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cittadini
authors.forename: Simone
authors.initials: S
authors.lastname: Negrini
authors.forename: Francesco
authors.initials: F
authors.lastname: Indiveri
authors.forename: Radu
authors.initials: R
authors.lastname: Tutuian
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Savarino
authors.forename: Massimo
authors.initials: M
authors.lastname: Ghio
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D017097:Electric Impedance; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011658:Pulmonary Fibrosis / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D012129:Respiratory Function Tests; D012595:Scleroderma, Systemic / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D055815:Young Adult