A Prospective Endoscopic Study of GERD in Japanese Systemic Sclerosis Patients

Abstract

Background: Systemic sclerosis (SSc) is one of systemic autoimmune disorders and the majority of patients are frequently suffered from GERD and erosive esophagitis. Recently, multicenter endoscopic survey of GERD was carried out in Japan. According to the report, the rate of erosive esophagitis was 16.7% and that of hiatal hernia was 49.3% (n=2560). However, suffering rate of esophagitis and hernia in Japanese SSc patients is unknown. Aim and Methods: To study the rate of esophagitis and hernia in Japanese SSc patients, prospective endoscopic examination using high resolution magnification endoscopy (HRME) was underwent. Consecutive diagnosed 54 SSc patients (79.6% female, 75.9% limited type, age 12-85 yr) in our hospital excluded post gastrectomy were enrolled. Informed consent was obtained from all patients. After evaluation of symptoms by QUEST questionnaire, endoscopic examination by HRME (EG-485, 490, 590, 0.85- 1.35 million pixels, 50-100 time optical zoom, FTS Japan) was performed by one endoscopist. Endoscopic grading of GERD was evaluated by the modified Los Angeles Classification (Grade N: normal appearance, M: minimal change, A, B, C, D) and that of hiatal hernia was evaluated by the Makuuchi's Classification (Grade 0: normal, C: partial, B: minor, A: definite). In addition, atrophic change of the stomach was observed by Kimura & Takemoto Classification (C-0: normal, C1: partial, C-2, C-3, O1, O-2, O-3: severe atrophy). Results: Symptomatic GERD (QUEST score 5<) was 48.1% (26/54). The rate of erosive esophagitis (Grade A-D) was 31.5% (17/54). The other 37 patients were minimal change (Grade M) and no patient was normal. The rate of hiatal hernia (except normal) was 98.1% (53/54). The rate of normal and partial atrophic gastritis (C-0, C-1) was 50% (27/54). No cancerous lesion was found out. Conclusions: Suffering rates of GERD and hiatal hernia in Japanese SSc patients were significantly high than that of normal Japanese. These patients are considered as high risk group of Barrett's esophagus and strict follow up by endoscopy may be needed.