Gastrointestinal dysmotility is associated with proton pump inhibitor refractory oesophagitis in patients with systemic sclerosis

Objectives Patients with systemic sclerosis present with severe gastroesophageal reflux disease, often refractory to proton-pump inhibitors (PPI) treatment. The aim of the present study was to identify factors associated with PPI-refractory oesophagitis. Methods We performed a cross-sectional study in a single-centre cohort of patients diagnosed with systemic sclerosis. We included patients who underwent an oesophagogastroduodenoscopy while on PPI treatment. Patients with PPI-refractory erosive oesophagitis were compared with those with endoscopically normal oesophageal mucosa. Results A total of 69 patients were included. From these, 23 patients (33%) had PPI-refractory oesophagitis (Grade A, n = 11; Grade B, n = 7; Grade C, n = 2; Grade D, n = 3) and 46 (67%) had an endoscopically normal oesophageal mucosa. On univariate analysis, patients with PPI-refractory oesophagitis were more frequently diffuse SSc subset (43% vs 17%; P = 0.041). Evaluating gastrointestinal motility tests, neither absent oesophageal contractility (39% vs 25%, P = 0.292) nor hypotensive lower oesophageal sphincter (47% vs 44%, P = 0.980) were significantly associated with PPI-refractory oesophagitis. Gastrointestinal dysmotility, defined as abnormal gastric emptying and/or small bowel dilated loops, was significantly associated with PPI-refractory oesophagitis (66 vs 8%, P =<0.001). On a multivariate regression model to evaluate the association between motility test results adjusted for the diffuse subset, gastrointestinal dysmotility (beta = 0.751, P = 0.010) was independently associated with PPI-refractory oesophagitis, while absent oesophageal contractility (beta = 0.044, P = 0.886) or a hypotensive LES were not (beta = -0.131, P = 0.663). Conclusions Our findings suggest that gastric and small intestinal motor dysfunction may be an important contributor to the development of PPI-refractory oesophagitis in patients with systemic sclerosis. Graphical Abstract