Abstract

Proton pump inhibitor (PPI) twice daily dosing is a standard therapy for gastroesophageal reflux disease (GERD) in systemic sclerosis (SSc) but there is no data on its response rate or the predictors of PPI-partial response GERD. Aims were to determine the prevalence of PPI-partial response GERD in SSc and to define its predictors. A prospective study was conducted in SSc patients with GERD. The patients were treated with omeprazole 20 mg bid for 4 weeks. The severity of symptom-grading by visual analogue scale (VAS) and frequency of symptoms by frequency scale for symptoms of GERD (FSSG) were assessed at baseline and 4 weeks after treatment. PPI-partial response GERD was defined as less than 50% improvement in the VAS for severity of symptom as well as acid reflux score by FSSG after treatment. According to the sample size calculation, 243 SSc-GERD patients were enrolled; of whom 166 (68.3%) had the diffuse cutaneous SSc. PPI-partial response GERD was found in 131 SSc patients (prevalence 53.9%; 95%CI 47.4–60.3). The multivariate analysis revealed that esophageal dysphagia was an only predictor the PPI-partial response GERD (OR 1.82; 95%CI 1.01–3.29) while neither SSc subset nor severity of skin tightness were significantly associated with PPI-partial response GERD. Half of the SSc patients were PPI-partial response GERD. Esophageal dysphagia was the only predictor of PPI-partial response GERD in SSc patients. Screening for dysphagia before starting GERD treatment is helpful for assessment the risk of PPI refractoriness GERD in SSc patients.

Highlights

  • Proton pump inhibitor (PPI) twice daily dosing is a standard therapy for gastroesophageal reflux disease (GERD) in systemic sclerosis (SSc) but there is no data on its response rate or the predictors of PPIpartial response GERD

  • A total of 250 Systemic sclerosis (SSc) patients diagnosed GERD were recruited to the study of whom 5 were lost to follow up, one had drug withdrawal and death and one died suddenly

  • It is not surprising that our result revealed that dysphagia is a strongly predictor of PPI-partial response GERD in the SSc patients

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Summary

Introduction

Proton pump inhibitor (PPI) twice daily dosing is a standard therapy for gastroesophageal reflux disease (GERD) in systemic sclerosis (SSc) but there is no data on its response rate or the predictors of PPIpartial response GERD. PPI-partial response GERD was defined as less than 50% improvement in the VAS for severity of symptom as well as acid reflux score by FSSG after treatment. Esophageal dysphagia was the only predictor of PPI-partial response GERD in SSc patients. Gastroesophageal reflux disease (GERD) is a clinical presentation of esophageal involvement in both the diffuse cutaneous SSc (dcSSc) and limited cutaneous SSc (lcSSc) subsets. The GERD Questionnaire (GERD-Q) provides a non-invasive screening tool with high sensitivity for diagnosis of gastroesophageal reflux disease in systemic sclerosis[15]. GERD-Q could be used to diagnose GERD in SSc; when endoscopy cannot be performed (i.e., mouth opening is limited and/or 24 h pH monitoring is not available)

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