Does long term therapy with lansoprazole slow progression of oesophageal involvement in systemic sclerosis?
OBJECTIVE
Oesophageal scintigraphy is an effective, non-invasive screening test to detect oesophageal dysmotility and reflux. Our objective was to assess the long term effect of lansoprazole therapy on gastroesophageal dysmotility in systemic sclerosis (SSc).


METHODS
24 SSc patients were randomised to receive either lansoprazole 30 mg or placebo for 12 months. Gastroesophageal motility was assessed by scintigraphy at baseline, after 6 months and after 12 months. Symptoms were evaluated by self-reported gastrointestinal questionnaire.


RESULTS
Of 21 patients starting treatment, 17 (81%) completed the first 6 months and 13 (62%) completed the study. 3 patients from each group were withdrawn due to adverse events. As expected, lansoprazole appeared to decrease frequency of gastroesophageal symptoms in the first 6 months of treatment, but long term benefit was not evident. Scintigraphy showed worsening oesophageal dysmotility in SSc patients irrespective of lansoprazole treatment. In addition, early signs of dysmotility were found in asymptomatic patients. We found no correlation of scintigraphy findings with symptoms of gastroesophageal dysmotility.


CONCLUSIONS
Although lansoprazole 30 mg daily appears to suppress SSc-related gastroesophageal symptoms in the short term, benefit was not sustained at 12 months, and there was no evidence that progression of gastroesophageal motility was prevented. Scintigraphy findings did not correlate with symptoms of dysphagia.
Royal Free and University College Medical School, Centre for Rheumatology and Connective Tissue Diseases, Department of Medicine, University College London Hampstead Campus, Hampstead, London, UK.
A
A
Pakozdi
H
H
Wilson
C M
CM
Black
C P
CP
Denton
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D018450:Disease Progression; D004947:Esophagus / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D005769:Gastrointestinal Motility / Q000187:drug effects / Q000502:physiology; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D011877:Radionuclide Imaging; D012595:Scleroderma, Systemic / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D064747:Lansoprazole