TY - JOUR
T1 - Gastroesophageal reflux and pulmonary fibrosis in Scleroderma
T2 - A study using pH-impedance monitoring
AU - Savarino, Edoardo
AU - Bazzica, Marco
AU - Zentilin, Patrizia
AU - Pohl, Daniel
AU - Parodi, Andrea
AU - Cittadini, Giuseppe
AU - Negrini, Simone
AU - Indiveri, Francesco
AU - Tutuian, Radu
AU - Savarino, Vincenzo
AU - Ghio, Massimo
PY - 2009/3/1
Y1 - 2009/3/1
N2 - Rationale: Interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) is associated with increased morbidity and mortality. Gastroesophageal reflux (GER) is considered a contributing factor in the pathogenesis of ILD. Objectives: To characterize GER (acid and nonacid) in patients with SSc with and without ILD. Methods: Patients with SSc underwent pulmonary high-resolution computer tomography (HRCT) scan and 24-hour impedance-pH monitoring off-proton pump inhibitor therapy. The presence of pulmonary fibrosis was assessed using validated HRCT-scores. Reflux monitoring parameters included number of acid and nonacid reflux episodes, proximal migration of the refluxate, and distal esophageal acid exposure. Unless otherwise specified, data are presented as median (25th-75th percentile). Measurements and Main Results: Forty consecutive patients with SSc (35 female; mean age, 53 yr; range, 24-71; 15 patients with diffuse and 25 with limited SSc) were investigated; 18 (45%) patients with SSc had pulmonary fibrosis (HRCT score ≥ 7). Patients with SSc with ILD had higher (P <0.01) esophageal acid exposure (10.3 [7.5-15] vs. 5.2 [1.5-11]), higher (P <0.01) number of acid (41 [31-58] vs. 19 [10-23]) and nonacid (25 [20-35] vs. 17 [11-19]) reflux episodes, and higher (P <0.01) number of reflux episodes reaching the proximal esophagus (42.5 [31-54] vs. 15 [8-22]) compared with patients with SSc with normal HRCT scores. Pulmonary fibrosis scores (HRCT score) correlated well with the number of reflux episodes in the distal (r2 = 0.637) and proximal (r2 = 0.644) esophagus. Conclusions: Patients with SSc with ILD have more severe reflux (i.e., more reflux episodes and more reflux reaching the proximal esophagus). Whether or not the development of ILD in patients with SSc can be prevented by reflux-reducing treatments needs to be investigated.
AB - Rationale: Interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) is associated with increased morbidity and mortality. Gastroesophageal reflux (GER) is considered a contributing factor in the pathogenesis of ILD. Objectives: To characterize GER (acid and nonacid) in patients with SSc with and without ILD. Methods: Patients with SSc underwent pulmonary high-resolution computer tomography (HRCT) scan and 24-hour impedance-pH monitoring off-proton pump inhibitor therapy. The presence of pulmonary fibrosis was assessed using validated HRCT-scores. Reflux monitoring parameters included number of acid and nonacid reflux episodes, proximal migration of the refluxate, and distal esophageal acid exposure. Unless otherwise specified, data are presented as median (25th-75th percentile). Measurements and Main Results: Forty consecutive patients with SSc (35 female; mean age, 53 yr; range, 24-71; 15 patients with diffuse and 25 with limited SSc) were investigated; 18 (45%) patients with SSc had pulmonary fibrosis (HRCT score ≥ 7). Patients with SSc with ILD had higher (P <0.01) esophageal acid exposure (10.3 [7.5-15] vs. 5.2 [1.5-11]), higher (P <0.01) number of acid (41 [31-58] vs. 19 [10-23]) and nonacid (25 [20-35] vs. 17 [11-19]) reflux episodes, and higher (P <0.01) number of reflux episodes reaching the proximal esophagus (42.5 [31-54] vs. 15 [8-22]) compared with patients with SSc with normal HRCT scores. Pulmonary fibrosis scores (HRCT score) correlated well with the number of reflux episodes in the distal (r2 = 0.637) and proximal (r2 = 0.644) esophagus. Conclusions: Patients with SSc with ILD have more severe reflux (i.e., more reflux episodes and more reflux reaching the proximal esophagus). Whether or not the development of ILD in patients with SSc can be prevented by reflux-reducing treatments needs to be investigated.
KW - Acid and nonacid reflux
KW - Impedance pH-metry
KW - Pulmonary fibrosis
KW - Systemic sclerosis
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U2 - 10.1164/rccm.200808-1359OC
DO - 10.1164/rccm.200808-1359OC
M3 - Article
C2 - 19096004
AN - SCOPUS:63349106611
VL - 179
SP - 408
EP - 413
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
SN - 1073-449X
IS - 5
ER -