Published ahead of print on December 18, 2008, doi:10.1164/rccm.200808-1359OC
© 2009 American Thoracic Society doi: 10.1164/rccm.200808-1359OC
Gastroesophageal Reflux and Pulmonary Fibrosis in SclerodermaA Study Using pH-Impedance Monitoring1 Division of Gastroenterology and 2 Division of Clinical Immunology, Department of Internal Medicine, University of Genoa, Genoa, Italy; 3 Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland; and 4 Department of Radiology, University of Genoa, Genoa, Italy Correspondence and requests for reprints should be addressed to Edoardo Savarino, M.D., Division of Gastroenterology, University of Genoa, Viale Benedetto XV no. 6, 16132 Genoa, Italy. E-mail: edoardo.savarino{at}unige.it 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 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.
Key Words: systemic sclerosis • pulmonary fibrosis • impedance pH-metry • acid and nonacid reflux
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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. 
