Background/Purpose: Esophageal involvement is common in Systemic Sclerosis (SSc). It is estimated to occur in 70-90% of patients. Esophageal motor dysfunction is characterized by hypotonia of lower esophageal sphincter (LES) and mild peristalsis or aperistalsis in 2/3 of the esophagus. There is evidence that interstitial lung disease (ILD) and pulmonary fibrosis in SSc are associated with episodes of microaspirations secondary to gastroesophageal reflux disease (GERD).
The aim of this study was to determine if GERD is associated with ILD in SSc patients.

Methods: An observational retrospective cohort study was conducted during the period 1983-2016 in a single hospital centre. Diagnosis of GERD was established by typical clinical symptoms of heartburn and regurgitation. Esophageal manometry was performed to evaluate motility and was classified as: hypotensive LES (<10mmHg) and ineffective or absence of peristalsis at the distal esophagus. Pulmonary involvement was performed by high resolution computed tomography. Pulmonary function tests were performed with carbon monoxide diffusing capacity (DLCO) and forced vital capacity (FVC). Demographic, serological, clinical, and respiratory functional tests were analyzed. For quantitative and qualitative variables, Student’s T, Mann-Whitney, and Chi-2 were used, respectively. The hazard ratio values were obtained with a 95% confidence interval. Values of p≤0.05 were considered statistically significant.

Results: 125 patients with SSc were included, of whom 91 (72.8%) had GERD, with female predominance in both groups. Comparatively between the groups that presented GERD and those that did not, the age at diagnosis was similar and the time of evolution of the disease was 7 years vs 2 (p <0.001) respectively. In terms of disease subtypes, no statistically significant differences were found between patients with GERD and those who did not. Among the clinical characteristics analyzed, the presence of GER was not associated with cardiac involvement while it was for digital ulcers (36/91 vs 4/34; p=0.003). There were no significant differences in the immunological profile. The decrease in DLCO <70% and FVC <70% were more frequent in patients with GERD (49.4% vs 23.5%, 47.2% vs 23.5%; p=0.009). Alterations in esophageal manometry were more frequent in patients with GERD 59.34% (p=0.035) All data are detailed in the table below.

Conclusion: Significant differences were found when evaluating complementary studies such as DLCO <70%, FVC <70% and esophageal manometry, indicating that there is an association between GERD and ILD. A statistically significant finding was the association between the presence of digital ulcers and the presence of GERD.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/reduction-of-dlco-and-fvc-in-patients-with-gerd-and-systemic-sclerosis/