Abnormal esophageal acid exposure on high-dose proton pump inhibitor therapy is common in systemic sclerosis patients

Abstract

Background

Esophageal dysfunction and gastro-esophageal reflux disease (GERD) are common among patients with systemic sclerosis (SSc). Although high-dose proton pump inhibitors (PPIs) typically normalize esophageal acid exposure, the effectiveness of PPI therapy has not been systematically studied in SSc patients. The aim of this study was to characterize reflux in SSc patients on high-dose PPI using esophageal pH-impedance testing.

Methods

In this case-controlled retrospective analysis, 38 patients fulfilling 2013 American College of Rheumatology SSc criteria who underwent esophageal pH-impedance testing on twice-daily PPI between January 2014 and March 2017 at a tertiary referral center were compared with a control-cohort of 38 non-SSc patients matched for PPI formulation and dose, hiatal hernia size, age, and gender. Patient clinical characteristics, including endoscopy and high-resolution manometry findings, were assessed via chart review.

Key Results

On pH-impedance, SSc patients had higher acid exposure times (AETs) than controls. Sixty-one percent of the SSc patients and 18% of the control patients had a total AET ≥4.5% (P < .001). Systemic sclerosis patients also had significantly longer AETs, longer median bolus clearance, and lower nocturnal impedance values.

Conclusions & Inferences

Abnormal esophageal acid exposure despite high-dose PPI therapy was common among patients with SSc. The lack of increased reflux episodes in the SSc patients, and longer bolus clearance times and lower nocturnal impedance, supports ineffective clearance as the potential mechanism. Systemic sclerosis patients may require adjunctive therapies to PPIs to control acid reflux.

Esophageal dysfunction and reflux are common in patients with systemic sclerosis yet the effectiveness of acid suppression therapy in these patients has not been systematically studied. Our study indicates that systemic sclerosis patients have significant esophageal acid exposure despite high-dose proton pump inhibitor therapy, suggesting ineffective esophageal clearance as a mechanism. Patients with systemic sclerosis may need adjunctive therapies in addition to acid suppression to control their reflux.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2AqlMoc