Esophageal Involvement and Gastroesophageal Reflux Disease in Systemic Sclerosis: A Tertiary Center Experience

Year 2021, , 705 - 709, 17.09.2021

Ferhat Bacaksız , Ömer Öztürk , Derya Arı , İlyas Tenlik , Volkan Gökbulut , Yakup Ergün , Yasemin Özderin , Ertuğrul Kayaçetin

https://doi.org/10.16899/jcm.854821

Abstract

Aim: Esophagus is the most frequently involved gastrointestinal segment in systemic sclerosis (SS). Gastroesophageal reflux, which occurs with the motility disorder caused by esophageal involvement, has an important place in the course of the disease due to many local and systemic complications. In this study, we investigated the demographic features, endoscopic, manometric, and 24-hour pH monitoring findings of patients with SS.
Materials and Methods: Twenty-six patients with SS who presented with dysphagia or heartburn complaints were identified. Patients' files, endoscopic, manometric, and 24-hour ph monitoring findings of the esophagus were examined.
Results: All of the patients were symptomatic, 96.1% were women. 46.1% of them applied with the complaint of heartburn and 53.9% with the complaint of dysphagia. The frequency of esophagitis was found to be significantly higher (p = 0.005). Pathological reflux was detected in 90% of the patients who underwent 24-hour pH monitoring and it was significantly higher (p = 0.013).
Conclusion: Esophageal involvement is a hallmark manifestation of SS and typically occurs secondary to heartburn and dysphagia.In our society, the incidence of GERD and GERD-related complications is high in SS patients with esophageal symptoms. It is important to refer these patients to experienced gastroenterology centers to be evaluated primarily by endoscopic and then other diagnostic methods.

Keywords

esophageal motility disorder, gastroesophageal reflux disease, systemic sclerosis

Supporting Institution

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Project Number

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Sistemik Skleroz’da Özofagus Tutulumu ve Gastroözofageal Reflü Hastalığı: Üçüncü Basamak Deneyimi

Abstract

Amaç: Özofagus sistemik sklerozda (SS) en sık tutulan gastrointestinal segmenttir. Özofagus tutulumunun yol açtığı motilite bozukluğu ile ortaya çıkan gastroözofageal reflü hastalığı, birçok lokal ve sistemik komplikasyon nedeniyle hastalığın seyrinde önemli bir yere sahiptir. Bu çalışmamızda SS tanılı hastaların demografik özelliklerini, endoskopik, manometrik ve 24 saatlik ph monitorizasyonu bulgularını araştırdık.
Gereç ve Yöntem: Disfaji veya heartburn şikayetleri ile başvurmuş olan 26 SS tanılı hasta tespit edildi. Hastaların, dosyaları, endoskopik, manometrik ve özofagusun 24 saatlik ph monitorizasyonu bulguları incelendi.
Bulgular: Hastaların tamamı semptomatikti, %96,1’i kadındı. %46,1 ’i heartburn şikayetiyle, %53,9’u disfaji şikayetiyle başvurmuştu. Özofajit sıklığı anlamlı ölçüde yüksek saptandı (p=0,005). 24 saatlik ph monitorizasyonu yapılan hastaların %90’ında patolojik reflü tespit edilmişti ve anlamlı derecede yüksekti (p=0,013).
Sonuç: Özofageal tutulum SS' nin karakteristik tutulumlarından biridir. Özofagus tutulumu, heartburn ve disfaji gibi şikayetler ile kendini gösterir. Toplumumuzda, özofagus semptomları olan SS hastalarında GÖRH ve GÖRH ile ilişkili komplikasyonların görülme sıklığı yüksektir. Bu hastaların öncelikle endoskopik ve sonra diğer tanı yöntemleri ile değerlendirilmesi için deneyimli gastroenteroloji merkezlerine yönlendirilmesi önem arz etmektedir.

Keywords

gastroözofageal reflü hastalığı, özofafus motilite bozuklukları, sistemik skleroz

Project Number

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References

• Gilliland BC. Systemic sclerosis (scleroderma). In: Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, eds. Harrison’s Principles of Internal Medicine, 15th ed. USA: McGraw-Hill Comp. Inc; 2001. p. 1937-945.
• Gyger G, Baron M. Systemic sclerosis gastrointestinal disease and its management. Rheum Dis Clin 2015; 41:459–473.
• Bharadwaj S, Tandon P, Gohel T, Corrigan ML, Coughlin KL, Shatnawei A, Chatterjee S, Kirby DF. Gastrointestinal manifestations, malnutrition, and role of enteral and parenteral nutrition in patients with scleroderma. J Clin Gastroenterol 2015; 49:559–564.
• Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 2013; 108:308.
• Highland KB, Garin MC, Brown KK. The spectrum of scleroderma lung disease. Semin Respir Crit Care Med 2007; 28:418–429.
• Mustafa Akif Sarıyıldız, İbrahim Batmaz, Mahmut Budulgan, et al. Sistemik sklerozlu hastalarda depresif semptomlar: Klinik değişkenler, fonksiyonel durum ve yaşam kalitesi ile ilişkisi. Dicle Tıp Dergisi 2013; 40 (1): 62-67.
• Hanan Sayed M. Abozaid, Hala M.K. Imam, Marwa Mahmoud Abdelaziz, et al. High resolution manometry compared with the University of California, Los Angeles Scleroderma Clinical Trials Consortium GIT 2.0 in Systemic Sclerosis. Semin Arthritis Rheum 2017; Dec;47 (3):403-408.
• I. Marie, P. Ducrott´e, P. Denis, M. F. Hellot, and H. Levesque. Oesophageal mucosal involvement in patients with systemic sclerosis receiving proton pump inhibitor therapy. Alimentary Pharmacology and Therapeutics 2006; 24:11-12, p. 1593– 601.
• D. A. Katzka, J. C. Reynolds, S. H. Saul et al. Barrett’s metapalasia and adenocarcinoma of the esophagus in scleroderma. The American Journal of Medicine 1987 vol. 82, pp. 46–52.
• Wipff J, Coriat R, Masciocchi M, et al. Outcomes of Barrett’s oesophagus related to systemic sclerosis: a 3-year EULAR Scleroderma Trials and Research prospective follow-up study. Rheumatology 2011; 50:1440-444.
• M. Lahcene, N. Oumnia, N.Matougui, et al. Esophageal Involvement in Scleroderma: Clinical, Endoscopic, and Manometric Features. ISRN Rheumatology Volume 2011, Article ID 325826.
• T. J. Poirier and G. B. Rankin. Gastrointestinal manifestations of progressive systemic scleroderma based on a review of 364 cases. The American Journal of Gastroenterology 1972 vol. 58, no. 1, pp. 30–44.
• J. Hostein, R. Bost, P. Carpentier, A. Franco et al. Motricit´e oesophagienne au cours de la maladie de Raynaud de la scl´erodermie et du syndrome de Raynaud pr´escl´erodermique. Gastroenterologie Clinique et Biologique 1985 vol. 9, no. 2, pp. 130–135.
• G. Lock, A. Holstege, B. Lang et al. Gastrointestinal manifestations of progressive systemic sclerosis. The American Journal of Gastroenterology 1997 vol. 92, no. 5, pp. 763–771.
• Ntoumazios SK, Voulgari PV, Potsis K, et al. Esophageal involvement in scleroderma: gastroesophageal reflux, the common problem. Semin Arthritis Rheum 2006; 36: 173–181.
• Baron M, Bernier P, Cote LF, et al. Screening and therapy for malnutrition and related gastro-intestinal disorders in systemic sclerosis: recommendations of a North American expert panel. Clin Exp Rheumatol 2010; 28: S42–6.
• Savarino E, Bazzica M, Zentilin P, et al. Gastroesophageal reflux and pulmonary fibrosis in scleroderma: a study using pH-impedance monitoring. Am J Respir Crit Care Med 2009; 179: 408–413.
• Fisichella PM, Reder NP, Gagermeier J et al. Usefulness of pH monitoring in predicting the survival status of patients with scleroderma awaiting lung transplantation. Journal of surgical research 2014; 232-237.
• Ragunath K, Williams J G. A review of oesophageal manometry testing in a district general hospital. Postgrad Med J 2002; 78 (915): 34–6.
• D. C. Calderaro, M. A. P. de Carvalho, L. D. Moretzsohn. Esophageal manometry in 28 systemic sclerosis Brazilian patients: findings and correlations. Diseases of the Esophagus (2009) 22, 700–704.
• Simeon CP, Castro-Guardiola A, Fonollosa V, et al. Systemic sclerosis in men: clinical and immunological differences. Br J Rheumatol 1996; 35:910-1.
• Abu-Shakra M, Guillemin F, Lee P. Gastrointestinal manifestations of systemic sclerosis. Semin Arthritis Rheum 1994;24: 29-39.