Session Information
Date: Monday, November 9, 2015
Title: Systemic Sclerosis, Fibrosing Syndromes and Raynaud's - Clinical Aspects and Therapeutics Poster II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Systemic sclerosis (SSc)
is a connective tissue disease involving the skin and visceral organs, most
commonly the gastrointestinal tract and lungs. Interstitial lung disease
(ILD) is present in up to 75% of cases and is the leading cause of mortality in
SSc. Recent studies have shown a correlation
between gastroesophageal reflux (GER) and SSc-ILD,
however, doubt remains regarding the extent to which GER affects ILD. In this study we compared GER, esophageal
dysmotility and lower esophageal sphincter (LES) tone
in those with and without ILD, hypothesizing that the presence and extent of
esophageal involvement would correlate with presence and extent of ILD.
Methods: A retrospective review identified
thirty-nine patient cases of SSc that met diagnostic
criteria as set by the American College of Rheumatology. Data were
collected from high-resolution computed tomography (HRCT), pulmonary function
testing (PFT), esophageal pH-Impedance testing (pH-I) and high-resolution
esophageal manometry (HREM) to assess GER, esophageal dysmotility and lower
esophageal sphincter tone in those with and without ILD. Significant GER was defined as DeMeester
score > 14.72 on pH-I and Goh criteria3 were used to stage ILD as
limited or extensive.
Results: The ILD and non-ILD groups were similar
in regards to sex, age, disease duration or modified Rodnan skin score. Patients with ILD had higher rates of
significant GER at 75% vs. 33% of controls (p = 0.01). The ILD group also had higher rates of absent
peristalsis at 100% vs. 59% (p = 0.009) and hypotensive LES at 92% vs.
70% (p = 0.13). In subgroup
analysis of those with extensive ILD vs. limited ILD, 83% vs. 50% had
significant GER (p = 0.19). These results are listed below in Table 1.
|
Table 1. Demographics and data of ILD (N=12) vs. non-ILD (N=27) groups and Extensive ILD3 (N=6) vs. Limited ILD3 groups (N=6). (mean ± SD)
|
||
|
Demographics
|
ILD
|
Non-ILD
|
|
Age (years) |
56.71 ± 11.95 |
58.50 ±12.72 p = 0.67
|
|
Sex (male) |
17% (2 of 12) |
11% (3 of 27) p = 0.62
|
|
SSc duration1 (years) |
10.07 ± 8.89 |
5.58 ± 4.25 p = 0.11
|
|
MRSS |
14.15 ± 12.81 |
21.00 ± 12.04 p = 0.14
|
|
Data
|
||
|
Significant GER2 |
75 % (8 of 12) |
33% (9 of 27) p = 0.01
|
|
Average DeMeester |
43.35 ± 38.92 |
29.66 ± 56.47 p = 0.45
|
|
Absent peristalsis |
100% (12 of 12) |
59% (16 of 27) p = 0.009
|
|
Hypotensive LES |
92% (11 of 12) |
70% (19 of 27) p = 0.13
|
|
Extensive ILD3
|
Limited ILD3
|
|
|
Significant GER2 |
83% (5 of 6) |
50% (3 of 6) p = 0.19
|
|
Average DeMeester |
49.83 ± 43.74 |
36.87 ± 36.31 p = 0.59
|
|
Abbreviations: ILD = Interstitial lung disease. SSc = Systemic sclerosis. MRSS = Modified Rodnan Skin Score. GER = Gastroesophageal reflux. LES = Lower esophageal sphincter. 1: Defined by first onset of non-Raynaud’s phenomenon SSc feature. 2: Determined as DeMeester score greater than 14.72 on pH-Impedance testing. 3: As outlined by Goh N.S., et al. Interstitial lung disease in systemic sclerosis: a simple staging system. AJRCCM. 177, 1248-1254 (2008).
|
||
Conclusion: We report a statistically significant
positive correlation between SSc-ILD and the presence
of significant GER or esophageal dysmotility, with a trend toward extensive ILD
in those with more severe GER. These findings support the notion that GER
likely contributes to the development and progression of SSc-ILD,
and that aggressive medical or surgical treatment of GER is warranted to
decrease the morbidity and mortality associated with ILD.
To cite this abstract in AMA style:
Bulian B, Griffing WL, Crowell M. Correlation of Scleroderma Interstitial Lung Disease with Gastroesophageal Reflux [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/correlation-of-scleroderma-interstitial-lung-disease-with-gastroesophageal-reflux/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/correlation-of-scleroderma-interstitial-lung-disease-with-gastroesophageal-reflux/