Background/Purpose: Interstitial lung disease (ILD) is the leading cause of death in Systemic Sclerosis (SSc) but its pathogenesis is not fully understood. Esophageal disease is common in SSc and micro-aspiration of both acid and non-acid gastroesophageal reflux could be involved in the pathogenesis of ILD. Esophagogastroduodenoscopy (EGD) is an essential tool to evaluate disease severity of upper gastrointestinal tract involvement in SSc. The objective of the present study is to assess the role of EGD in predicting pulmonary functional deterioration in SSc patients.

Methods: One hundred and fifty patients with SSc and suspected esophageal involvement underwent EGD. Pulmonary function tests were performed at baseline and after a 36-months follow-up. Patients were characterized for disease phenotype, BMI, smoking exposure and medication history. A significant ILD progression was defined as a relative decline ≥10% of FVC or a concomitant decline ≥5% of FVC and ≥15% of DLCO.

Results: One hundred and thirty-six patients (90.5%) were female with a mean age of 55.6 ± 13.8 years and 12.1% were active smokers. Fifty patients (33.3%) had a diffuse cutaneous disease; 37.4% and 40.8% were positive for anti-centromere and anti-Scl70 antibodies respectively. The mean disease duration from the first non-Raynaud symptom was 5.9±6.7 years. Sixty-one patients (40.8%) showed EGD signs of reflux esophagitis. Among them, 31.3% had an erosive form (9.5% grade A, 15.6% grade B, 4.8% grade C and 1.4% grade D according to Los Angeles classification). At the baseline, 23.1% of the patients had a FVC≤80% and 45.6% had a DLCO≤50%. Patients with erosive esophagitis did not differ in terms of sex, age, duration and disease variant, positivity for anti-centromere, skin score values, FVC and DLCO at baseline compared to patients without erosions, but had a lower prevalence of anti-Scl70 (28.3 vs 52.5%, p=0.005) and active smoking (20.0 vs 8.4%, p=0.05). At follow-up, patients with esophageal erosions showed a greater relative decrease in FVC (3.4%±9.3% vs 1.7%±12.0%; p=0.013) without significant differences in the DLCO change. Overall, 11.0% of patients presented pulmonary disease progression. The presence of esophageal erosions was associated with a significantly greater risk of lung disease progression (OR 5.3, 95% CI 1.7-16.8, p=0.004) after paired correction for sex, age, duration of disease, auto-antibodies, skin involvement variant, baseline FVC and DLCO, smoke exposure and therapy with immunosuppressants, proton pump inhibitors, prokinetics, antiplatelet agents and prostanoids.

Conclusion: SSc patients with erosive esophagitis present a higher risk of progression of interstitial lung disease. This evidence supports a role of micro-aspiration of gastric contents in the development of inflammation and fibrosis of the airways.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/esophageal-erosion-predicts-progression-of-lung-disease-in-patients-with-systemic-sclerosis/