Esophageal Dysphagia Predicts PPI-Partial Response GERD in Patients With Systemic Sclerosis

systemic sclerosis
systemic sclerosis
A team of investigators sought to determine the prevalence of proton pump inhibitor-partial response gastroesophageal reflux disease in patients with systemic sclerosis.

Esophageal dysphagia may predict proton pump inhibitor (PPI)-partial response gastroesophageal reflux disease (GERD) in patients with systemic sclerosis (SSc), a study published in Science Reports suggests.

The study included 243 patients with SSc and GERD who were treated with omeprazole 20 mg twice daily for 4 weeks. The primary endpoint included the prevalence of PPI-partial response GERD following completion of the 4-week treatment regimen. The PPI-partial response GERD was defined as a less than 50% improvement in the visual analog scale for severity of symptoms and posttreatment acid reflux score after treatment. Secondary endpoints of the study included predictors of PPI-partial response GERD and measures of quality of life (QOL).

In the overall cohort, the mean age of the patients was 55.0 ± 9.8 years and ranged from 25.5 to 80.0 years. The median disease duration was 3.1 years, and the median duration of GERD after SSc onset was 1.8 years.

The prevalence of PPI-partial response GERD in the study population was 53.9% (95% CI, 47.4-60.3). The only predictor of PPI-partial response GERD in the multivariate analysis was the presence of esophageal dysphagia (odds ratio, 1.82; 95% CI, 1.01-3.29).

Most patients experienced stable or improved QOL following PPI treatment. The QOL metrics that had noticeable improvements included mobility (88%), self-care (94%), usual activities (87.7%), pain/discomfort (86.4%), and anxiety/depression (90.5%).

The researchers suggest their study is limited by the lack of undercontrolled confounders that possibly could have affected GERD symptoms and PPI treatment outcomes. These confounders included diet, lifestyle, and stress.

Despite these limitations, the study investigators indicate that “screening for dysphagia before starting GERD treatment is helpful for assessing the risk of PPI refractory GERD in SSc patients.”

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Foocharoen C, Chunlertrith K, Mairiang P, et al. Prevalence and predictors of proton pump inhibitor partial response in gastroesophageal reflux disease in systemic sclerosis: a prospective study. Sci Rep. 2020;10(1):769. doi:10.1038/s41598-020-57636-0