Prevalence and clinical importance of gastroesophageal reflux in Chinese patients with systemic sclerosis.
OBJECTIVE
To estimate the prevalence of gastroesophageal reflux (GER) and its clinical relevance with other manifestations in Chinese patients with systemic sclerosis (SSc).


METHODS
A prospective cross-sectional study of 205 Chinese patients with SSc was conducted at Peking Union Medical College Hospital (PUMCH). GER was diagnosed as mild heartburn or regurgitation ≥2 days per week, or moderate/severe heartburn or regurgitation ≥1 day a week. PAH was defined as pulmonary artery systolic pressure (PASP) >45mmHg at rest as estimated by transthoracic echocardiography (TTE). Demographic, clinical, and laboratory data were calculated between GER and non-GER groups, and relative examinations including a six-minute walk test, pulmonary function test and modified Rodnan skin score (mRSS) were also performed.


RESULTS
The prevalence of GER was 43.90% (90/205) among 205 Chinese patients with SSc. The presence of Raynaud phenomenon (98.9% vs. 92.2%), fingertip ulcers (56.7% vs. 51.3%), pulmonary arterial hypertension (PAH) (18.89% vs. 6.96%, respectively), and all gastrointestinal tract manifestations occurred significantly more frequent in patients with GER than in patients without GER, respectively (p<0.05). There were no differences in the development of any autoantibody between GER patients and non-GER patients (p>0.05). Echocardiography showed that the left ventricular ejection fraction (LVEF) was lower (62.27±10.48 vs. 70.09±5.26, respectively) and pericarditis was more frequent (22.6% vs. 11.0%, respectively) in SSc-related GER than in SSc patients without GER, respectively. The New York Heart Association (NYHA) functional class of SSc-related GER was worse than patients without GER (p=0.015). A pulmonary function test showed that forced vital capacity FVC% (78.93±17.90 vs. 84.55±17.45, respectively, p=0.042), forced expiratory volume FEV1% (77.12±15.65 vs. 84.30±16.25, respectively, p=0.004), and diffusing capacity DLCO% (4.76±1.76 vs. 5.63±2.12, respectively, p<0.001) were lower, and the FVC%/DLCO% ratio (1.46±0.42 vs. 1.28±0.27, respectively, p=0.001)was higher in SSc-related GER than non-GER patients (p<0.05). We also found that GER was an independent risk factor of PAH in SSc patients (p=0.030, OR=7.532).


CONCLUSIONS
GER is common in Chinese patients with SSc, and patients with GER are susceptible to microvascular damage. Therefore, SSc patients presenting with GER should be screened for PAH.
Department of Rheumatology, Chinese Academy of Medical Science, Beijing, China. lxjw2009@gmail.com
Xinjuan
X
Liu
Mengtao
M
Li
Dong
D
Xu
Yong
Y
Hou
Qian
Q
Wang
Zhuang
Z
Tian
Qiuning
Q
Sun
Xiaofeng
X
Zeng
D000293:Adolescent; D000328:Adult; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D002648:Child; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000208:ethnology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000208:ethnology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000208:ethnology*; D012720:Severity of Illness Index; D055815:Young Adult