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 (β = 0.751, P = 0.010) was independently associated with PPI-refractory oesophagitis, while absent oesophageal contractility (β = 0.044, P = 0.886) or a hypotensive LES were not (β = −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.

中文翻译：

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胃肠道运动障碍与系统性硬化症患者的质子泵抑制剂难治性食管炎有关


目的 系统性硬化症患者表现为严重的胃食管反流病，通常对质子泵抑制剂 （PPI） 治疗无效。本研究的目的是确定与 PPI 难治性食管炎相关的因素。方法 我们在诊断为系统性硬化症患者的单中心队列中进行了一项横断面研究。我们纳入了在接受 PPI 治疗期间接受食管胃十二指肠镜检查的患者。将 PPI 难治性糜烂性食管炎患者与内窥镜下食管粘膜正常的患者进行比较。结果 共纳入 69 例患者。其中，23 例患者 （33%） 患有 PPI 难治性食管炎 （A 级，n = 11;B 级，n = 7;C 级，n = 2;D 级，n = 3）和 46 例 （67%） 食管粘膜内窥镜正常。在单变量分析中，PPI 难治性食管炎患者更频繁地出现弥漫性 SSc 亚群 （43% vs 17%;P = 0.041）。评估胃肠道动力测试，食管收缩力缺失 （39% vs 25%，P = 0.292） 和低血压食管下括约肌 （47% vs 44%，P = 0.980） 均与 PPI 难治性食管炎显著相关。胃肠道动力障碍，定义为胃排空异常和/或小肠扩张袢，与 PPI 难治性食管炎显著相关 （66 vs 8%，P =<0.001）。在评估针对弥漫性子集调整的运动测试结果之间关联的多变量回归模型中，胃肠道运动障碍 （β = 0.751，P = 0.010） 与 PPI 难治性食管炎独立相关，而食管收缩力缺失 （β = 0.044，P = 0.886） 或低血压 LES 则不然 （β = -0.131，P = 0.663）。 结论 我们的研究结果表明，胃和小肠运动功能障碍可能是系统性硬化症患者 PPI 难治性食管炎发展的重要因素。