Gastroesophageal reflux and pulmonary fibrosis in scleroderma: a study using pH-impedance monitoring.
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.
Savarino
Edoardo
E
Division of Gastroenterology, University of Genoa, Genoa, Italy. edoardo.savarino@unige.it
Bazzica
Marco
M
Zentilin
Patrizia
P
Pohl
Daniel
D
Parodi
Andrea
A
Cittadini
Giuseppe
G
Negrini
Simone
S
Indiveri
Francesco
F
Tutuian
Radu
R
Savarino
Vincenzo
V
Ghio
Massimo
M
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