Published ahead of print on December 18, 2008, doi:10.1164/rccm.200808-1359OC Am. J. Respir. Crit. Care Med., Volume 179, Number 5, March 2009, 408-413 A more recent version of this article appeared on March 1, 2009
Submitted on August 28, 2008 Gastro-Esophageal Reflux and Pulmonary Fibrosis in Scleroderma: A Study Using pH-Impedance MonitoringEdoardo Savarino1*,1 Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy, 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, 4 Department of Radiology, University of Genoa, Genoa, Italy * To whom correspondence should be addressed. E-mail: esavarino{at}libero.it.
Introduction:
Interstitial lung disease (ILD) in systemic sclerosis (SSc) patients is associated with increased morbidity and mortality. Gastro-esophageal reflux (GER) is considered a contributing factor in the pathogenesis of ILD.
Aim:
To characterize gastro-esophageal reflux (acid and non-acid) in SSc patients with and without ILD.
Methods:
Patients with SSc underwent pulmonary high-resolution computer tomography (HRCT) scan and 24-h impedance-pH monitoring off-PPI therapy. The presence of pulmonary fibrosis was assessed using validated HRCT-scores. Reflux monitoring parameters included number of acid and non-acid reflux episodes, proximal migration of the refluxate and distal esophageal acid exposure. Unless otherwise specified data are presented as median [25th -75th percentile].
Results:
Forty consecutive SSc patients (35 female; mean age 53 years; range 24-71; 15 diffuse and 25 limited SSc) were investigated. Eighteen (45%) SSc patients had pulmonary fibrosis (HRCT score Key words: systemic sclerosis • pulmonary fibrosis • impedance pH-metry • acid and nonacid reflux
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7). SSc patients 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 non-acid (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 to SSc patients 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.
Conclusions:
SSc patients 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 SSc patients can be prevented by reflux reducing treatments needs to be investigated.
