Reflux oesophagitis in systemic sclerosis. Prospective evaluation of prevalence and risk factors

Aims: To evaluate the prevalence of reflux oesophagitis (RE) in systemic sclerosis (SS), define its severity and analyze the risk factors. Patients and methods: The study involved 173 consecutive cases of SS recruited prospectively over a period of 18 years (between April 1988 and June 2006, on 1980 ACR criteria). The mean age is 40.6 +/- 13.4 years, the sex-ratio 0.14 and the average duration 6.7 +/- 7.6 years. According to LeRoy et al. classification, 141 cases involved a located cutaneous form (81.5%) and 32 cases a diffuse form (18.5%). All the patients underwent a questionnaire concerning the presence and gradation of symptoms of reflux and/or dysphagia, an endoscopy and a standard oesophageal manometry. Twenty-four hour pH Monitoring was carried out on 89 patients. Results: RE was found in 62 patients (35.8%), being mild or moderate (A and B LA) in 41 cases (23.7%) and severe (C and D) or complicated in 21 cases (12.1%). Presence of REis not influenced by age, sex, duration or cutaneous extension of the disease. On the other hand, presence of oesophageal symptoms is a good indicator of the presence of mucous lesions. A pathological acid GER is almost constant in cases of RE in both upright and supine positions. GER index is higher in presence of RE than in its absence. The presence of the latter is statistically dependent on both lower oesophageal sphincter (LES) incompetence and oesophageal motor disorders. Moreover, the LES pressure and the distal oesophageal contractile amplitude wave are significantly lower in presence of RE than in its absence. Conclusions: Reflux oesophagitis is observed in over 30% of scleroderma. Its presence is not related to the age, sex, duration or extension of the disease. It is especially linked to the presence of GER and severe oesophageal motor disorders.