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
Summary
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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