The relationship between gastroesophageal reflux disease and severity of lung damage in systemic sclerosis


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Objective. To investigate the incidence and severity of gastroesophageal reflux disease (Gerd) and a potential relationship with severity of lung damage in systemic sclerosis. Material and methods. 56 patients (mean age 46±і4 years) with diffuse and limited form of systemic sclerosis were allocated to groups on the basis of the presence or absence of gastroesophageal reflux disease (The Montreal Classification). To detect the presence and evaluate severity of lung damage, all patients underwent standard clinical and diagnostic investigations, including gastroduodenoscopy, contrast esophagography and high resolution chest ct. Results. GERD was found in 27 of 56 (48.2%) patients. Of them, 24 patients were on continuous therapy with proton pump inhibitors and 3 received them for exacerbations. Among 23 patients who underwent esophagogastroduodenoscopy, 1 patient had erosive GERD, 11 patients - non-erosive GERD (esophageal mucosa hyperemia) and 11 were found to have esophageal functional changes (endoscopy-negative stage). All studied patients had moderate esophageal damage. According to Savary-Miller classification of reflux esophagitis severity, 1 patient had grade I reflux esophagitis; there were no cases of grades II, III and IV reflux esophagitis. Almost all GERD patients (26 of 27) had dysphagia, while it was observed only in 11 patients without GERD. Esophageal motility disturbances according to contrast esophagography were found in 20 of 25 (80%) patients with GERD compared to 5 of 24 (20.8%) without Gerd. Clinically significant dyspnea (NYHA>II) was detected twice as often in patients with GERD compared with patients without GERD (at 92.6% compared to 44.8%, RESPECTIVELY, P=0.0002). DYSPNEA (NYHA III) was detected 4 times more often in patients with GERD compared with patients without Gerd (44.4% compared to 1 0.3%, respectively, p=0,006). severe INTERSTITIAL LUNG DISEASE (OVER 20%) ACCORDING TO GOH ET al. staging system was significantly more common in PATIENTS WITH Gerd (74. 1 % COMPARED TO 37,5% WITHOUT Gerd, P=0.018). Conclusion. GERD is a common co-morbidity in systemic sclerosis. The study findings showed that more severe LUNG DISEASE WAS ASSOCIATED WITH GERD SUGGESTING A POTENTIAL CONTRIBUTION OF GERD TO THE DEVELOPMENT AND PROGRESSION OF PULMONARY FIBROSIS IN PATIENTS WITH SYSTEMIC SCLEROSIS.

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