Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Empiric long-term use of proton pump inhibitors (PPI) are implicated in concomitant renal dysfunction (1) and small intestinal bacterial overgrowth (SIBO)(2). Yet, experts recommend daily empiric PPI even in the absence of reflux symptomatology in SSc patients (3). The Prospective Registry of Early Systemic Sclerosis (PRESS) cohort of early diffuse cutaneous systemic sclerosis (dcSSc) permits determination of the utility of empiric PPI administration in this patient population.
Methods: The PRESS cohort includes dcSSc patients with < 2 years duration who are recruited at 11 United States Scleroderma Centers. Patients participate in detailed baseline and biannual clinical and laboratory assessments that permit examination of patient characteristics, PPI use, renal function and patient-reported clinical outcomes measures including the University of California Los Angeles Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.0 (GIT 2.0)(4).
Results: As of May 2016, 166 PRESS patients were enrolled (Table 1). At baseline and 6 months, 132 and 67 patients had completed the GIT 2.0 respectively. Of the 88 patients taking a PPI at baseline, 6 had no reflux, 37 had mild reflux, 28 had moderate reflux and 15 had severe reflux. Five patients taking PPI had renal dysfunction at baseline (defined as reduced creatinine clearance). No patient taking a PPI developed renal dysfunction between baseline and 6 months. Only 11 of the 88 patients on PPI lacked bloating or distention at baseline. At 6 months, only 1 patient with a repeat GIT 2.0 was newly prescribed that PPI. This patient lacked renal insufficiency and bloating or distention.
Conclusion: Most dcSSc patients take PPI. PPI use was not associated with incident renal dysfunction over 6 months follow-up. Bloating and distension are common symptoms in dcSSc patients and may be associated with PPI use. Due to recent associations of PPI with SIBO and renal dysfunction experts may consider changes in practice patterns. Cohorts such as PRESS provide the opportunity to understand gastrointestinal disease and renal dysfunction in the dcSSc patient population as well as the opportunity to study potential adverse effects of medications.
|Characteristic (n=166)||Number or mean|
|BMI (kg/m2)||25.7 ± 5.3|
|25 7 125 8 20|
| ANA positive
Autoantibody in ANA positive patients:
|128 6 60 38|
| SCTC completed:
| PPI use at baseline
|6 (23)* 37 (73) 28 (41) 15 (25)|
| PPI use at baseline:
|11(24) 36 (66) 8 (14) 12 (23)|
| PPI use and Renal function:
|69 (137) 3 (4) 1 (1) 1 (3) 2 (3)|
To cite this abstract in AMA style:Frech TM, Shah AA, Hinchcliff M, Castelino FV, Assassi S, Bernstein EJ, Domsic RT, Gordon JK, Shanmugam VK, Steen VD, Murtaugh M, LaSalle B, Khanna D, Hant FN. Anti-Reflux Medications in Diffuse Cutaneous Systemic Sclerosis: Is Empiric Use of Proton Pump Inhibitors Supported? [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/anti-reflux-medications-in-diffuse-cutaneous-systemic-sclerosis-is-empiric-use-of-proton-pump-inhibitors-supported/. Accessed November 27, 2020.
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