1
|
Elahee M, Domsic RT. Managing Symptoms of Systemic Sclerosis for the Allergist-Immunologist. Curr Allergy Asthma Rep 2024; 24:433-441. [PMID: 38904933 DOI: 10.1007/s11882-024-01155-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE OF REVIEW Systemic sclerosis (SSc) is a chronic, multisystem, autoimmune disease characterized by fibrosis, vasculopathy and immune system dysregulation. We provide a comprehensive review of features of systemic sclerosis that can potentially present to the allergist. RECENT FINDINGS A thorough understanding of the management options is crucial for clinicians involved in the care of patients with SSc to optimize clinical outcomes. Management of systemic sclerosis has drastically changed in the last decade and continues to evolve. This review provides an overview of management strategies for the various symptoms including skin, upper and lower airway, gastrointestinal and vascular manifestations. Institution of treatment early in the disease, including referral to rheumatology or specialized scleroderma centers, can help to both prevent and manage disease complications, and improve patient quality-of-life. While the landscape of systemic sclerosis management has evolved, we continue to recognize that there is still a need for better biomarkers and targeted therapies.
Collapse
Affiliation(s)
- Mehreen Elahee
- University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Robyn T Domsic
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States.
| |
Collapse
|
2
|
Kuribayashi S, Nakamura F, Motegi SI, Hara K, Hosaka H, Sekiguchi A, Ishikawa M, Endo Y, Harada T, Sorimachi H, Obokata M, Uchida M, Yamaguchi K, Uraoka T. Prevalence and risk factors for medication-refractory reflux esophagitis in patients with systemic sclerosis in Japan. J Gastroenterol 2024; 59:179-186. [PMID: 38252140 DOI: 10.1007/s00535-024-02076-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUNDS Patients with systemic sclerosis (SSc) often have esophageal motility abnormalities and weak esophago-gastric junction (EGJ) barrier function, which causes proton pump inhibitor (PPI)-refractory reflux esophagitis (RE). The aims of this study were to clarify the current management of RE and prevalence and risk factors of medication-refractory RE in patients with SSc in Japan. METHODS A total of 188 consecutive patients with SSc who underwent both esophageal high-resolution manometry (HRM) and esophagogastroduodenoscopy (EGD) were reviewed. The presence of RE and grades of the gastroesophageal flap valve (GEFV) were assessed. Esophageal motility was assessed retrospectively according to the Chicago classification v3.0. When RE was seen on a standard dose of PPI or any dose of vonoprazan (VPZ), it was defined as medication-refractory RE. RESULTS Approximately 80% of patients received maintenance therapy with acid secretion inhibitors regardless of esophageal motility abnormalities. Approximately 50% of patients received maintenance therapy with PPI, and approximately 30% of patients received VPZ. Medication-refractory RE was observed in 30 patients (16.0%). In multivariable analyses, the number of EGD and absent contractility were significant risk factors for medication-refractory RE. Furthermore, combined absent contractility and GEFV grade III or IV had higher odds ratios than did absent contractility alone. CONCLUSIONS Patients with persistent reflux symptoms and those with absent contractility and GEFV grade III or IV should receive maintenance therapy with strong acid inhibition to prevent medication-refractory RE.
Collapse
Affiliation(s)
- Shiko Kuribayashi
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi Maebashi, Gunma, 371-8511, Japan.
| | - Fumihiko Nakamura
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi Maebashi, Gunma, 371-8511, Japan
| | - Sei-Ichiro Motegi
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kenichiro Hara
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroko Hosaka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi Maebashi, Gunma, 371-8511, Japan
| | - Akiko Sekiguchi
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Mai Ishikawa
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yukie Endo
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tomonari Harada
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hidemi Sorimachi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Mitsuo Uchida
- Department of Public Health, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Koichi Yamaguchi
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-15 Showa-Machi Maebashi, Gunma, 371-8511, Japan
| |
Collapse
|
3
|
Marten Canavesio Y, Pasta A, Calabrese F, Alessandri E, Cutolo M, Paolino S, Pizzorni C, Sulli A, Savarino V, Giannini EG, Zentilin P, Bodini G, Furnari M, Savarino E, Marabotto E. Association between esophageal motor disorders and pulmonary involvement in patients affected by systemic sclerosis: a retrospective study. Rheumatol Int 2023:10.1007/s00296-023-05399-y. [PMID: 37542603 DOI: 10.1007/s00296-023-05399-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/19/2023] [Indexed: 08/07/2023]
Abstract
Systemic sclerosis (SSc) is a rare autoimmune disease of the connective tissue that can affect multiple organs. The esophagus is the most affected gastrointestinal tract, while interstitial lung disease (ILD) is a main feature associated with SSc. The aim of the present study was to evaluate the association and prognostic implication between motor esophageal disorders and pulmonary involvement in SSc patients. We retrospectively assessed patients with SSc who underwent both the HRM with the new Chicago Classification 4.0 and pulmonary evaluation comprehensive of function tests and high-resolution computer tomography (HrCT) with the use of Warrick score. A total score ≥ 7 was considered predictive of ILD, while a score ≥ 10 in a HrCT acquired prospectively from baseline evaluation was considered to establish significant interstitial involvement. Forty-two patients were included. We found a score ≥ 7 in 11 patients with aperistalsis, in 6 subjects with IEM and in 6 patients with a normal manometry. Otherwise, a score < 7 was observed in 3 patients with aperistalsis, and in 2 and 14 patients with IEM and with a normal contractility, respectively. Higher scores were observed in subjects with absent contractility or ineffective esophageal motility than subjects with normal motility, indeed DCI and HrCT score were inversely correlated in linear and logarithmic regression analysis. Prospectively, lower baseline LESP and greater HrCT scores at follow-up evaluation were significantly correlated. This study shows an association between motor esophageal disorder and pulmonary involvement in SSc patients: more severe is the esophageal involvement, more critical is the pulmonary disease.
Collapse
Affiliation(s)
- Ylenia Marten Canavesio
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS-Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Andrea Pasta
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS-Ospedale Policlinico San Martino, 16132, Genoa, Italy.
| | - Francesco Calabrese
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS-Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Elisa Alessandri
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine DiMI, University of Genoa, IRCCS San Martino Polyclinic, Genoa, Italy
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine DiMI, University of Genoa, IRCCS San Martino Polyclinic, Genoa, Italy
| | - Sabrina Paolino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine DiMI, University of Genoa, IRCCS San Martino Polyclinic, Genoa, Italy
| | - Carmen Pizzorni
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine DiMI, University of Genoa, IRCCS San Martino Polyclinic, Genoa, Italy
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine DiMI, University of Genoa, IRCCS San Martino Polyclinic, Genoa, Italy
| | - Vincenzo Savarino
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS-Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Edoardo Giovanni Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS-Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Patrizia Zentilin
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS-Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Giorgia Bodini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS-Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Manuele Furnari
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS-Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Gastroenterology Unit, Azienda Ospedale Università di Padua, Padua, Italy
| | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS-Ospedale Policlinico San Martino, 16132, Genoa, Italy
| |
Collapse
|
4
|
Volkmann ER, Tashkin DP, Leng M, Kim GHJ, Goldin J, Roth MD. Association of Symptoms of Gastroesophageal Reflux, Esophageal Dilation, and Progression of Systemic Sclerosis-Related Interstitial Lung Disease. Arthritis Care Res (Hoboken) 2023; 75:1690-1697. [PMID: 36504432 PMCID: PMC10258217 DOI: 10.1002/acr.25070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/15/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate whether symptoms of gastroesophageal reflux disease and radiographic measures of esophageal dilation are associated with radiographic progression of systemic sclerosis-related interstitial lung disease (SSc-ILD). METHODS Participants of the Scleroderma Lung Study II, which compared mycophenolate versus cyclophosphamide for SSc-ILD, completed the reflux domain of the University of California Los Angeles Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.0 at baseline. The diameter and area of the esophagus in the region of maximum dilation was measured by quantitative image analysis. Univariate and multivariable linear regression analyses were created to evaluate the relationship between these measures of esophageal involvement and progression of SSc-ILD over 2 years, based on the radiologic quantitative interstitial lung disease (QILD) and quantitative lung fibrosis (QLF) in the lobe of maximum involvement (LM). All multivariable models controlled for the treatment arm, baseline ILD severity, and proton-pump inhibitor use. RESULTS The baseline mean patient-reported reflux score was 0.57, indicating moderate reflux (n = 141). Baseline mean maximal esophageal diameter and area were 22 mm and 242 mm2 , respectively. Baseline reflux scores were significantly associated with the change in QLF-LM and QILD-LM in the univariate and multivariable models. Neither radiographic measure of esophageal dilation was associated with the change in radiographic measures of lung involvement. CONCLUSION Severity of reflux symptoms as measured by an SSc-specific questionnaire was independently associated with the change in the radiographic extent of ILD and fibrosis over 2 years in patients with SSc-ILD. Two objective measures of esophageal dilation were not associated with radiographic progression of ILD, highlighting the need for improved objective measures of esophageal dysfunction in SSc.
Collapse
Affiliation(s)
- Elizabeth R. Volkmann
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine; USA
| | - Donald P. Tashkin
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine; USA
| | - Mei Leng
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine; USA
| | - Grace Hyun J. Kim
- Department of Radiology, University of California, Los Angeles, David Geffen School of Medicine; USA
| | - Jonathan Goldin
- Department of Radiology, University of California, Los Angeles, David Geffen School of Medicine; USA
| | - Michael D. Roth
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine; USA
| |
Collapse
|
5
|
Tucker AE, Perin J, Volkmann ER, Abdi T, Shah AA, Pandolfino J, Silver RM, McMahan ZH. Associations Between Patterns of Esophageal Dysmotility and Extra-Intestinal Features in Patients With Systemic Sclerosis. Arthritis Care Res (Hoboken) 2023; 75:1715-1724. [PMID: 36576023 PMCID: PMC11019887 DOI: 10.1002/acr.25080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/29/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The gastrointestinal tract is commonly involved in patients with systemic sclerosis (SSc) with varied manifestations. As our understanding of SSc gastrointestinal disease pathogenesis and risk stratification is limited, we sought to investigate whether patterns of esophageal dysfunction associate with specific clinical phenotypes in SSc. METHODS Patients enrolled in the Johns Hopkins Scleroderma Center Research Registry who completed high-resolution esophageal manometry (HREM) studies as part of their clinical care between 2011 and 2020 were identified. Associations between esophageal abnormalities on HREM (absent contractility [AC], ineffective esophageal motility [IEM], hypotensive lower esophageal sphincter [hypoLES]) and patient demographic information, clinical characteristics, and autoantibody profiles were examined. RESULTS Ninety-five patients with SSc had HREM data. Sixty-five patients (68.4%) had AC (37 patients with only AC, 28 patients with AC and a hypoLES), 9 patients (9.5%) had IEM, and 11 patients (11.6%) had normal studies. AC was significantly associated with diffuse cutaneous disease (38.5% versus 10.0%; P < 0.01), more severe Raynaud's phenomenon, including digital pits, ulcers, or gangrene (56.9% versus 30.0%; P = 0.02), and reduced median diffusing capacity of lung for carbon monoxide (50.6% versus 72.2%; P = 0.03). AC was observed in most of the patients who died (13 of 14; P = 0.06). These findings were not seen in patients with IEM. CONCLUSION Among patients with SSc, AC is associated with a significantly more severe clinical phenotype. IEM may associate with a milder phenotype. Further studies are needed to evaluate AC, IEM, and their clinical impact relative to the timing of other end-organ complications in SSc.
Collapse
Affiliation(s)
- Ana E Tucker
- Medical University of South Carolina, Charleston
| | - Jamie Perin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Tsion Abdi
- Johns Hopkins University, Baltimore, Maryland
| | - Ami A Shah
- Johns Hopkins University, Baltimore, Maryland
| | | | | | | |
Collapse
|
6
|
Viewpoint: a multidisciplinary approach to the assessment of patients with systemic sclerosis-associated interstitial lung disease. Clin Rheumatol 2023; 42:653-661. [PMID: 36271064 PMCID: PMC9935731 DOI: 10.1007/s10067-022-06408-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/03/2022]
Abstract
Systemic sclerosis (SSc) is a rare and heterogeneous disease affecting the skin and internal organs. SSc-associated ILD (SSc-ILD) is a common and often early manifestation of SSc. This article discusses the rationale for a multidisciplinary approach (MDA) to the early identification and assessment of patients with SSc-ILD. Diagnosis of SSc-ILD is often challenging as patients with early disease can be asymptomatic, and SSc-ILD symptoms, such as exertional dyspnea and cough, are non-specific. High-resolution computed tomography (HRCT) of the lungs is the gold standard for diagnosis of SSc-ILD since pulmonary function tests lack sensitivity and specificity, especially in early disease. On HRCT, most patients with SSc-ILD have a non-specific interstitial pneumonia (NSIP) pattern. In addition, findings of pulmonary hypertension and esophageal dysmotility may be present. The multi-organ involvement of SSc and the diverse spectrum of symptoms support an MDA for the diagnosis and assessment of patients with SSc-ILD, with input from rheumatologists, pulmonologists, gastroenterologists, radiologists, and other specialists. Key Points • Interstitial lung disease (ILD) is a common manifestation of systemic sclerosis (SSc). • Early diagnosis is key to reducing the morbidity and mortality associated with SSc-ILD and other manifestations of SSc. • The multi-organ involvement of SSc supports a multidisciplinary approach to the diagnosis and assessment of patients with SSc-ILD, with input from rheumatologists, pulmonologists, gastroenterologists, radiologists, and other specialists.
Collapse
|
7
|
Hughes M, Allanore Y, Baron M, Del Galdo F, Denton CP, Frech T, Furst DE, Galetti I, Dagna L, Herrick AL, Kuwana M, Matucci-Cerinic P, McMahan ZH, Murray CD, Proudman S, Matucci-Cerinic M. Proton pump inhibitors in systemic sclerosis: a reappraisal to optimise treatment of gastro-oesophageal reflux disease. THE LANCET. RHEUMATOLOGY 2022; 4:e795-e803. [PMID: 37936680 PMCID: PMC10628971 DOI: 10.1016/s2665-9913(22)00183-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Gastroesophageal reflux disease (GERD) is associated with significant morbidity in patients with systemic sclerosis (SSc). Although the introduction of proton pump inhibitors (PPIs) into clinical care have represented a major achievement in the management of oesophago-gastric problems in SSc, PPIs are seldom fully effective in SSc patients, and the utilization of maximum PPI dosages is a very frequent clinical practice. However, currently there is little evidence currently to support the empiric use of PPIs in SSc which is especially relevant in regard to safety concerns of long-term exposure with have been raised in the general population. The purpose of this viewpoint is to highlight the significant beneficial impact of PPIs on GERD in SSc, while considering the potential adverse effects in this patient population. Furthermore, we highlight the unmet needs of SSc patients with GERD, and also propose an agenda for future research to optimise the safe and effective use of PPIs in SSc.
Collapse
Affiliation(s)
- Michael Hughes
- Tameside Hospital, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, United Kingdom
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom
| | - Yannick Allanore
- Service de Rhumatologie, Hôpital Cochin, APHP, Université de Paris, Paris, France
| | - Murray Baron
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Francesco Del Galdo
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Christopher P Denton
- Centre for Rheumatology, Royal Free Campus, University College London, United Kingdom
| | - Tracy Frech
- Vanderbilt University Medical Center, Department of Medicine, Division of Rheumatology and Immunology, Nashville, TN, USA
| | - Daniel E Furst
- Department of Experimental and Clinical Medicine, University of Florence & Department of Geriatric Medicine, Division of Rheumatology AOUC, Florence, Italy
- Division of Rheumatology, Department of Medicine, University of California in Los Angeles, Los Angeles, California, USA
| | - Ilaria Galetti
- FESCA, Federation of European Scleroderma Associations, Belgium
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital & Vita-Salute San Raffaele University, Milan, Italy
| | - Ariane L Herrick
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom
- Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Pietro Matucci-Cerinic
- University Hospital, Santa Maria della Misericordia, Department of Surgery and Transplantation, University of Udine, Italy
| | - Zsuzsanna H McMahan
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Rheumatology, Baltimore, MD
| | - Charles D Murray
- Jewish General Hospital, Division of Rheumatology, McGill University, Montreal, Canada
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital and Discipline of Medicine, University of Adelaide, Adelaide, South Australia, 5000
| | - Marco Matucci-Cerinic
- Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital & Vita-Salute San Raffaele University, Milan, Italy
- Dept. Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy
| |
Collapse
|
8
|
Marabotto E, Savarino V, Savarino E. Towards a more precise classification of esophageal motility disorders in patients with systemic sclerosis. Neurogastroenterol Motil 2022; 34:e14416. [PMID: 35593267 DOI: 10.1111/nmo.14416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/21/2022] [Accepted: 05/04/2022] [Indexed: 02/08/2023]
Abstract
Systemic sclerosis (SSc) is a chronic and generalized disease affecting the connective tissue of the skin and many internal organs, in particular the gastrointestinal tract. The esophagus is involved in up to 80% of the cases and represents a major cause of serious morbidities that deeply impact on the quality of life and survival of patients. Indeed, the presence of esophageal dysfunction is a good prognostic indicator in SSc, primarily due to its impact on pulmonary disease. Thus, the detection of esophageal motility alterations plays a critical role to prevent the development of both esophageal and pulmonary complications and to improve the survival of these patients. Currently, this diagnostic work-up has been limited to the use of esophageal manometry, which is considered the gold standard for the evaluation of motor physiology and pathophysiology of this organ in different clinical situations. However, in recent years, new equipments such as high-resolution (-impedance) manometry and functional luminal imaging probe have been developed and used in many esophageal clinical settings, including SSc. In this mini-review, we summarize current evidence regarding esophageal dysmotility, in the light of new data on secondary peristalsis published in this issue of the journal.
Collapse
Affiliation(s)
- Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Vincenzo Savarino
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Gastroenterology Unit, Azienda Ospedale Università di Padova, Padua, Italy
| |
Collapse
|
9
|
Varma S, Yun JH, Kim JS, Podolanczuk AJ, Patel NM, Bernstein EJ. Clinical characteristics associated with small airways disease in systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2022; 7:128-134. [DOI: 10.1177/23971983221083882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/05/2022] [Indexed: 11/16/2022]
Abstract
Objective: Pulmonary manifestations of systemic sclerosis are a major cause of morbidity and mortality. Small airways disease can cause dyspnea and pulmonary function test abnormalities. We aimed to determine the prevalence of small airways disease and describe the characteristics associated with small airways disease in a cohort of systemic sclerosis patients. Methods: We performed a retrospective cohort study of adults with systemic sclerosis who met American College of Rheumatology/European League Against Rheumatism 2013 classification criteria and were evaluated at our institution between November 2000 and November 2015. Patients with prior lung transplantation were excluded. Small airways disease was defined as the presence of one or more of the following: airway-centered fibrosis on surgical lung biopsy, forced expiratory volume at 25–75% ⩽ 50% on pulmonary function tests, and/or high-resolution computed tomography scan of the chest with bronchiolitis, mosaic attenuation, or air trapping on expiratory views. The primary outcome was small airways disease diagnosis. We performed multivariable logistic regression to determine the association of clinical variables with small airways disease. Results: One-hundred thirty-six systemic sclerosis patients were included; 55 (40%) had small airways disease. Compared to those without small airways disease, a significantly greater proportion of those with small airways disease had interstitial lung disease, chronic obstructive pulmonary disease, pulmonary hypertension, and gastroesophageal reflux disease. On multivariable analysis, pulmonary hypertension (odds ratio = 2.91, 95% confidence interval = 1.11–7.65, p-value = 0.03), gastroesophageal reflux disease (odds ratio = 2.70, 95% confidence interval = 1.08–6.79, p-value = 0.034), and anti-topoisomerase I (anti-Scl-70) antibody positivity (odds ratio = 0.42, 95% confidence interval = 0.19–0.93, p-value = 0.033) were associated with diagnosis of small airways disease. Conclusion: Small airways disease is prevalent among systemic sclerosis patients; those with pulmonary hypertension or gastroesophageal reflux disease may have a higher risk of small airways disease.
Collapse
Affiliation(s)
- Sanskriti Varma
- Department of Medicine, NewYork-Presbyterian and Columbia University Irving Medical Center, New York, NY, USA
| | - Jae Hee Yun
- Department of Medicine, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - John S Kim
- Department of Medicine, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Anna J Podolanczuk
- Division of Pulmonary and Critical Care, Weill Cornell Medicine, New York, NY, USA
| | - Nina M Patel
- Division of Pulmonary and Critical Care, Columbia University Irving Medical Center, New York, NY, USA
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Elana J Bernstein
- Division of Rheumatology, Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
10
|
Abstract
The gastrointestinal tract is the second largest organ system in the body and is often affected by connective tissue disorders. Scleroderma is the classic rheumatologic disease affecting the esophagus; more than 90% of patients with scleroderma have esophageal involvement. This article highlights esophageal manifestations of scleroderma, focusing on pathogenesis, clinical presentation, diagnostic considerations, and treatment options. In addition, this article briefly reviews the esophageal manifestations of other key connective tissue disorders, including mixed connective tissue disease, myositis, Sjogren syndrome, systemic lupus erythematosus, fibromyalgia, and Ehlers-Danlos syndrome.
Collapse
Affiliation(s)
- Nitin K Ahuja
- Division of Gastroenterology and Hepatology, University of Pennsylvania, 3400 Civic Center Boulevard 7 South Pavilion, Philadelphia, PA 19104, USA
| | - John O Clarke
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway Street, Pavilion C, 3rd Floor, C-343, Redwood City, CA 94063-6341, USA.
| |
Collapse
|
11
|
Yayla ME, Balcı G, Torgutalp M, Eroğlu DŞ, Dinçer ABK, Gülöksüz EGA, Sezer S, Yüksel ML, Ateş A, Turgay TM, Kınıklı G. Interstitial Lung Disease in Systemic Sclerosis: A Single-Center Retrospective Analysis. Curr Rheumatol Rev 2021; 18:150-156. [PMID: 34517806 DOI: 10.2174/1573397117666210913104029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/08/2021] [Accepted: 06/08/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Systemic sclerosis (SSc) is a systemic autoimmune disease characterized by microangiopathy, inflammation, fibrosis. Interstitial lung disease (ILD) is common among SSc patients. OBJECTIVE This study aims to define the clinical, laboratory and serologic characteristics of SSc patients with ILD and to present the frequency of chest computed tomography features. METHODS Two hundred twenty-six SSc patients who applied to the Rheumatology Department between January 2007 and August 2019 were retrospectively examined. A total of 100 SSc patients with ILD (44.2 %) were determined. Clinical, laboratory and serological features of SSc patients with and without ILD were compared. RESULT Both groups had similar characteristics in terms of age and sex. The duration of disease (p=0.001) and follow-up time (p=0.001) were longer in SSc patients with ILD. Multivariable logistic regression analysis indicated that the duration of disease (OR: 1.06 [1.01-1.13], p=0.029), presence of gastrointestinal system involvement (OR: 3.29 [1.28-8.46], p=0.013) and anti-SCL70-positivity (OR: 6.04 [2.35-15.49], p<0.001) were associated with ILD. There was an inverse relationship between Anti-CENP-B positivity and the presence of ILD (p=0.001). The assessment regarding the chest computed tomography characteristics of interstitial pneumonia patterns were as follows: 82.5% non-specific interstitial pneumonia, 14.4% usual interstitial pneumonia and 2.1% desquamative interstitial pneumonia. The most frequent abnormal findings included ground glass opacification (88.7%), reticulation (64.9%), traction bronchiectasis (57.7%), septal thickening (52.6%) and honey combing (28.9%). CONCLUSION We have shown that there is a relationship between anti-SCL70, disease duration, gastrointestinal system involvement and ILD in SSc patients.
Collapse
Affiliation(s)
- Müçteba Enes Yayla
- Clinic of Rheumatology, Ankara Training and Research Hospital, Ankara. Turkey
| | - Gülşah Balcı
- Department of Internal Medicine, Ankara University Faculty of Medicine, Ankara. Turkey
| | - Murat Torgutalp
- Department of Rheumatology, Ankara University Faculty of Medicine, Ankara. Turkey
| | - Didem Şahin Eroğlu
- Department of Rheumatology, Ankara University Faculty of Medicine, Ankara. Turkey
| | | | | | - Serdar Sezer
- Department of Rheumatology, Ankara University Faculty of Medicine, Ankara. Turkey
| | - Mehmet Levent Yüksel
- Department of Rheumatology, Ankara University Faculty of Medicine, Ankara. Turkey
| | - Aşkın Ateş
- Department of Rheumatology, Ankara University Faculty of Medicine, Ankara. Turkey
| | - Tahsin Murat Turgay
- Department of Rheumatology, Ankara University Faculty of Medicine, Ankara. Turkey
| | - Gülay Kınıklı
- Department of Rheumatology, Ankara University Faculty of Medicine, Ankara. Turkey
| |
Collapse
|
12
|
Showalter K, Hoffmann A, Richardson C, Aaby D, Lee J, Dematte J, Agrawal R, Savas H, Wu X, Chang RW, Hinchcliff M. Esophageal Dilation and Other Clinical Factors Associated with Pulmonary Function Decline in Patients with Systemic Sclerosis. J Rheumatol 2021; 48:1830-1838. [PMID: 34266985 DOI: 10.3899/jrheum.210533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify clinical factors, including esophageal dilation on chest high-resolution computed tomography (HRCT), that are associated with pulmonary function decline in patients with systemic sclerosis (SSc). METHODS Patients fulfilled 2013 SSc criteria and had ≥1 HRCT and ≥2 pulmonary function tests (PFTs). According to published methods, widest esophageal diameter (WED) and radiographic interstitial lung disease (ILD) were assessed, and WED was dichotomized as dilated (≥19mm) vs. not dilated (<19mm). Clinically meaningful PFT decline was defined as %-predicted change in forced vital capacity (FVC) ≥5 and/or diffusion capacity for carbon monoxide (DLCO) ≥15. Linear mixed effect models were used to model PFT change over time. RESULTS 138 SSc patients met study criteria: 100 (72%) had radiographic ILD; 49 (35%) demonstrated FVC decline (median follow-up 2.9y). Patients with Scl-70 autoantibodies had 5- year %-predicted FVC decline (-6.3; 95% CI -9.9, -2.8), while patients without Scl-70 autoantibodies demonstrated 5-year FVC stability (+1.78; 95% CI -0.6, 4.15). Esophageal diameter did not distinguish between those with vs. without FVC decline. Patients with esophageal dilation had statistically significant 5-year %-predicted DLCO decline (-5.6; 95% CI - 10.0, -1.2), but this decline was unlikely clinically significant. Similar results were observed in sub-analysis of patients with radiographic ILD. CONCLUSION In patients with SSc, Scl-70 positivity is a risk factor for %-predicted FVC decline at five years. Esophageal dilation on HRCT was associated with a minimal, non-clinically significant decline in DLCO and no change in FVC during 5-year follow-up. These results have prognostic implications for SSc-ILD patients with esophageal dilation.
Collapse
Affiliation(s)
- Kimberly Showalter
- Northwestern University Feinberg School of Medicine Department of Medicine 240 E. Huron Street, Suite 1-200 Chicago, IL 60611; Hospital for Special Surgery Department of Medicine, Division of Rheumatology 535 E. 70th Street New York, NY 10021; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Rheumatology 240 E. Huron Street Suite M-300 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Preventive Medicine 680 N. Lake Shore Drive Suite 1400 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine 633 N St. Clair 18th Floor Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Pulmonary and Critical Care Medicine 240 E Huron, McGaw M-300; Northwestern University Feinberg School of Medicine Department of Radiology 251 E. Huron Street, 4th Floor Chicago, IL 60611; hNew York Presbyterian/Weill Cornell Department of Medicine, Division of Pulmonary and Critical Care Medicine 1305 York Ave, 10th floor, Y-1053 New York, NY 10065; Yale School of Medicine Department of Medicine, Section of Rheumatology, Allergy & Immunology The Anlyan Center 300 Cedar Street PO Box 208031 New Haven, CT 06520. Financial support: Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers K23 AR059763 (MH), R01 AR073270 (MH), P60 AR064464 (RWC, KK, JL), and P30 AR072579 (RWC, JL) and National Center for Advancing Translational Sciences-Clinical and Translational Science Award Number UL1 TR000150 (JL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Rheumatology Research Foundation (KS), Scleroderma Foundation (KS), and the Scleroderma Research Foundation (MH) also supported this work. Corresponding author: Monique Hinchcliff, MD MS, Associate Professor of Medicine, Yale School of Medicine, Department of Medicine, Section of Allergy, Rheumatology & Immunology, The Anlyan Center, 300 Cedar Street, PO Box 208031, New Haven, CT 06520.
| | - Aileen Hoffmann
- Northwestern University Feinberg School of Medicine Department of Medicine 240 E. Huron Street, Suite 1-200 Chicago, IL 60611; Hospital for Special Surgery Department of Medicine, Division of Rheumatology 535 E. 70th Street New York, NY 10021; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Rheumatology 240 E. Huron Street Suite M-300 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Preventive Medicine 680 N. Lake Shore Drive Suite 1400 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine 633 N St. Clair 18th Floor Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Pulmonary and Critical Care Medicine 240 E Huron, McGaw M-300; Northwestern University Feinberg School of Medicine Department of Radiology 251 E. Huron Street, 4th Floor Chicago, IL 60611; hNew York Presbyterian/Weill Cornell Department of Medicine, Division of Pulmonary and Critical Care Medicine 1305 York Ave, 10th floor, Y-1053 New York, NY 10065; Yale School of Medicine Department of Medicine, Section of Rheumatology, Allergy & Immunology The Anlyan Center 300 Cedar Street PO Box 208031 New Haven, CT 06520. Financial support: Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers K23 AR059763 (MH), R01 AR073270 (MH), P60 AR064464 (RWC, KK, JL), and P30 AR072579 (RWC, JL) and National Center for Advancing Translational Sciences-Clinical and Translational Science Award Number UL1 TR000150 (JL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Rheumatology Research Foundation (KS), Scleroderma Foundation (KS), and the Scleroderma Research Foundation (MH) also supported this work. Corresponding author: Monique Hinchcliff, MD MS, Associate Professor of Medicine, Yale School of Medicine, Department of Medicine, Section of Allergy, Rheumatology & Immunology, The Anlyan Center, 300 Cedar Street, PO Box 208031, New Haven, CT 06520.
| | - Carrie Richardson
- Northwestern University Feinberg School of Medicine Department of Medicine 240 E. Huron Street, Suite 1-200 Chicago, IL 60611; Hospital for Special Surgery Department of Medicine, Division of Rheumatology 535 E. 70th Street New York, NY 10021; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Rheumatology 240 E. Huron Street Suite M-300 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Preventive Medicine 680 N. Lake Shore Drive Suite 1400 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine 633 N St. Clair 18th Floor Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Pulmonary and Critical Care Medicine 240 E Huron, McGaw M-300; Northwestern University Feinberg School of Medicine Department of Radiology 251 E. Huron Street, 4th Floor Chicago, IL 60611; hNew York Presbyterian/Weill Cornell Department of Medicine, Division of Pulmonary and Critical Care Medicine 1305 York Ave, 10th floor, Y-1053 New York, NY 10065; Yale School of Medicine Department of Medicine, Section of Rheumatology, Allergy & Immunology The Anlyan Center 300 Cedar Street PO Box 208031 New Haven, CT 06520. Financial support: Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers K23 AR059763 (MH), R01 AR073270 (MH), P60 AR064464 (RWC, KK, JL), and P30 AR072579 (RWC, JL) and National Center for Advancing Translational Sciences-Clinical and Translational Science Award Number UL1 TR000150 (JL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Rheumatology Research Foundation (KS), Scleroderma Foundation (KS), and the Scleroderma Research Foundation (MH) also supported this work. Corresponding author: Monique Hinchcliff, MD MS, Associate Professor of Medicine, Yale School of Medicine, Department of Medicine, Section of Allergy, Rheumatology & Immunology, The Anlyan Center, 300 Cedar Street, PO Box 208031, New Haven, CT 06520.
| | - David Aaby
- Northwestern University Feinberg School of Medicine Department of Medicine 240 E. Huron Street, Suite 1-200 Chicago, IL 60611; Hospital for Special Surgery Department of Medicine, Division of Rheumatology 535 E. 70th Street New York, NY 10021; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Rheumatology 240 E. Huron Street Suite M-300 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Preventive Medicine 680 N. Lake Shore Drive Suite 1400 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine 633 N St. Clair 18th Floor Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Pulmonary and Critical Care Medicine 240 E Huron, McGaw M-300; Northwestern University Feinberg School of Medicine Department of Radiology 251 E. Huron Street, 4th Floor Chicago, IL 60611; hNew York Presbyterian/Weill Cornell Department of Medicine, Division of Pulmonary and Critical Care Medicine 1305 York Ave, 10th floor, Y-1053 New York, NY 10065; Yale School of Medicine Department of Medicine, Section of Rheumatology, Allergy & Immunology The Anlyan Center 300 Cedar Street PO Box 208031 New Haven, CT 06520. Financial support: Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers K23 AR059763 (MH), R01 AR073270 (MH), P60 AR064464 (RWC, KK, JL), and P30 AR072579 (RWC, JL) and National Center for Advancing Translational Sciences-Clinical and Translational Science Award Number UL1 TR000150 (JL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Rheumatology Research Foundation (KS), Scleroderma Foundation (KS), and the Scleroderma Research Foundation (MH) also supported this work. Corresponding author: Monique Hinchcliff, MD MS, Associate Professor of Medicine, Yale School of Medicine, Department of Medicine, Section of Allergy, Rheumatology & Immunology, The Anlyan Center, 300 Cedar Street, PO Box 208031, New Haven, CT 06520.
| | - Jungwha Lee
- Northwestern University Feinberg School of Medicine Department of Medicine 240 E. Huron Street, Suite 1-200 Chicago, IL 60611; Hospital for Special Surgery Department of Medicine, Division of Rheumatology 535 E. 70th Street New York, NY 10021; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Rheumatology 240 E. Huron Street Suite M-300 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Preventive Medicine 680 N. Lake Shore Drive Suite 1400 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine 633 N St. Clair 18th Floor Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Pulmonary and Critical Care Medicine 240 E Huron, McGaw M-300; Northwestern University Feinberg School of Medicine Department of Radiology 251 E. Huron Street, 4th Floor Chicago, IL 60611; hNew York Presbyterian/Weill Cornell Department of Medicine, Division of Pulmonary and Critical Care Medicine 1305 York Ave, 10th floor, Y-1053 New York, NY 10065; Yale School of Medicine Department of Medicine, Section of Rheumatology, Allergy & Immunology The Anlyan Center 300 Cedar Street PO Box 208031 New Haven, CT 06520. Financial support: Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers K23 AR059763 (MH), R01 AR073270 (MH), P60 AR064464 (RWC, KK, JL), and P30 AR072579 (RWC, JL) and National Center for Advancing Translational Sciences-Clinical and Translational Science Award Number UL1 TR000150 (JL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Rheumatology Research Foundation (KS), Scleroderma Foundation (KS), and the Scleroderma Research Foundation (MH) also supported this work. Corresponding author: Monique Hinchcliff, MD MS, Associate Professor of Medicine, Yale School of Medicine, Department of Medicine, Section of Allergy, Rheumatology & Immunology, The Anlyan Center, 300 Cedar Street, PO Box 208031, New Haven, CT 06520.
| | - Jane Dematte
- Northwestern University Feinberg School of Medicine Department of Medicine 240 E. Huron Street, Suite 1-200 Chicago, IL 60611; Hospital for Special Surgery Department of Medicine, Division of Rheumatology 535 E. 70th Street New York, NY 10021; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Rheumatology 240 E. Huron Street Suite M-300 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Preventive Medicine 680 N. Lake Shore Drive Suite 1400 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine 633 N St. Clair 18th Floor Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Pulmonary and Critical Care Medicine 240 E Huron, McGaw M-300; Northwestern University Feinberg School of Medicine Department of Radiology 251 E. Huron Street, 4th Floor Chicago, IL 60611; hNew York Presbyterian/Weill Cornell Department of Medicine, Division of Pulmonary and Critical Care Medicine 1305 York Ave, 10th floor, Y-1053 New York, NY 10065; Yale School of Medicine Department of Medicine, Section of Rheumatology, Allergy & Immunology The Anlyan Center 300 Cedar Street PO Box 208031 New Haven, CT 06520. Financial support: Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers K23 AR059763 (MH), R01 AR073270 (MH), P60 AR064464 (RWC, KK, JL), and P30 AR072579 (RWC, JL) and National Center for Advancing Translational Sciences-Clinical and Translational Science Award Number UL1 TR000150 (JL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Rheumatology Research Foundation (KS), Scleroderma Foundation (KS), and the Scleroderma Research Foundation (MH) also supported this work. Corresponding author: Monique Hinchcliff, MD MS, Associate Professor of Medicine, Yale School of Medicine, Department of Medicine, Section of Allergy, Rheumatology & Immunology, The Anlyan Center, 300 Cedar Street, PO Box 208031, New Haven, CT 06520.
| | - Rishi Agrawal
- Northwestern University Feinberg School of Medicine Department of Medicine 240 E. Huron Street, Suite 1-200 Chicago, IL 60611; Hospital for Special Surgery Department of Medicine, Division of Rheumatology 535 E. 70th Street New York, NY 10021; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Rheumatology 240 E. Huron Street Suite M-300 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Preventive Medicine 680 N. Lake Shore Drive Suite 1400 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine 633 N St. Clair 18th Floor Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Pulmonary and Critical Care Medicine 240 E Huron, McGaw M-300; Northwestern University Feinberg School of Medicine Department of Radiology 251 E. Huron Street, 4th Floor Chicago, IL 60611; hNew York Presbyterian/Weill Cornell Department of Medicine, Division of Pulmonary and Critical Care Medicine 1305 York Ave, 10th floor, Y-1053 New York, NY 10065; Yale School of Medicine Department of Medicine, Section of Rheumatology, Allergy & Immunology The Anlyan Center 300 Cedar Street PO Box 208031 New Haven, CT 06520. Financial support: Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers K23 AR059763 (MH), R01 AR073270 (MH), P60 AR064464 (RWC, KK, JL), and P30 AR072579 (RWC, JL) and National Center for Advancing Translational Sciences-Clinical and Translational Science Award Number UL1 TR000150 (JL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Rheumatology Research Foundation (KS), Scleroderma Foundation (KS), and the Scleroderma Research Foundation (MH) also supported this work. Corresponding author: Monique Hinchcliff, MD MS, Associate Professor of Medicine, Yale School of Medicine, Department of Medicine, Section of Allergy, Rheumatology & Immunology, The Anlyan Center, 300 Cedar Street, PO Box 208031, New Haven, CT 06520.
| | - Hatice Savas
- Northwestern University Feinberg School of Medicine Department of Medicine 240 E. Huron Street, Suite 1-200 Chicago, IL 60611; Hospital for Special Surgery Department of Medicine, Division of Rheumatology 535 E. 70th Street New York, NY 10021; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Rheumatology 240 E. Huron Street Suite M-300 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Preventive Medicine 680 N. Lake Shore Drive Suite 1400 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine 633 N St. Clair 18th Floor Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Pulmonary and Critical Care Medicine 240 E Huron, McGaw M-300; Northwestern University Feinberg School of Medicine Department of Radiology 251 E. Huron Street, 4th Floor Chicago, IL 60611; hNew York Presbyterian/Weill Cornell Department of Medicine, Division of Pulmonary and Critical Care Medicine 1305 York Ave, 10th floor, Y-1053 New York, NY 10065; Yale School of Medicine Department of Medicine, Section of Rheumatology, Allergy & Immunology The Anlyan Center 300 Cedar Street PO Box 208031 New Haven, CT 06520. Financial support: Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers K23 AR059763 (MH), R01 AR073270 (MH), P60 AR064464 (RWC, KK, JL), and P30 AR072579 (RWC, JL) and National Center for Advancing Translational Sciences-Clinical and Translational Science Award Number UL1 TR000150 (JL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Rheumatology Research Foundation (KS), Scleroderma Foundation (KS), and the Scleroderma Research Foundation (MH) also supported this work. Corresponding author: Monique Hinchcliff, MD MS, Associate Professor of Medicine, Yale School of Medicine, Department of Medicine, Section of Allergy, Rheumatology & Immunology, The Anlyan Center, 300 Cedar Street, PO Box 208031, New Haven, CT 06520.
| | - Xiaoping Wu
- Northwestern University Feinberg School of Medicine Department of Medicine 240 E. Huron Street, Suite 1-200 Chicago, IL 60611; Hospital for Special Surgery Department of Medicine, Division of Rheumatology 535 E. 70th Street New York, NY 10021; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Rheumatology 240 E. Huron Street Suite M-300 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Preventive Medicine 680 N. Lake Shore Drive Suite 1400 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine 633 N St. Clair 18th Floor Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Pulmonary and Critical Care Medicine 240 E Huron, McGaw M-300; Northwestern University Feinberg School of Medicine Department of Radiology 251 E. Huron Street, 4th Floor Chicago, IL 60611; hNew York Presbyterian/Weill Cornell Department of Medicine, Division of Pulmonary and Critical Care Medicine 1305 York Ave, 10th floor, Y-1053 New York, NY 10065; Yale School of Medicine Department of Medicine, Section of Rheumatology, Allergy & Immunology The Anlyan Center 300 Cedar Street PO Box 208031 New Haven, CT 06520. Financial support: Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers K23 AR059763 (MH), R01 AR073270 (MH), P60 AR064464 (RWC, KK, JL), and P30 AR072579 (RWC, JL) and National Center for Advancing Translational Sciences-Clinical and Translational Science Award Number UL1 TR000150 (JL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Rheumatology Research Foundation (KS), Scleroderma Foundation (KS), and the Scleroderma Research Foundation (MH) also supported this work. Corresponding author: Monique Hinchcliff, MD MS, Associate Professor of Medicine, Yale School of Medicine, Department of Medicine, Section of Allergy, Rheumatology & Immunology, The Anlyan Center, 300 Cedar Street, PO Box 208031, New Haven, CT 06520.
| | - Rowland W Chang
- Northwestern University Feinberg School of Medicine Department of Medicine 240 E. Huron Street, Suite 1-200 Chicago, IL 60611; Hospital for Special Surgery Department of Medicine, Division of Rheumatology 535 E. 70th Street New York, NY 10021; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Rheumatology 240 E. Huron Street Suite M-300 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Preventive Medicine 680 N. Lake Shore Drive Suite 1400 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine 633 N St. Clair 18th Floor Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Pulmonary and Critical Care Medicine 240 E Huron, McGaw M-300; Northwestern University Feinberg School of Medicine Department of Radiology 251 E. Huron Street, 4th Floor Chicago, IL 60611; hNew York Presbyterian/Weill Cornell Department of Medicine, Division of Pulmonary and Critical Care Medicine 1305 York Ave, 10th floor, Y-1053 New York, NY 10065; Yale School of Medicine Department of Medicine, Section of Rheumatology, Allergy & Immunology The Anlyan Center 300 Cedar Street PO Box 208031 New Haven, CT 06520. Financial support: Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers K23 AR059763 (MH), R01 AR073270 (MH), P60 AR064464 (RWC, KK, JL), and P30 AR072579 (RWC, JL) and National Center for Advancing Translational Sciences-Clinical and Translational Science Award Number UL1 TR000150 (JL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Rheumatology Research Foundation (KS), Scleroderma Foundation (KS), and the Scleroderma Research Foundation (MH) also supported this work. Corresponding author: Monique Hinchcliff, MD MS, Associate Professor of Medicine, Yale School of Medicine, Department of Medicine, Section of Allergy, Rheumatology & Immunology, The Anlyan Center, 300 Cedar Street, PO Box 208031, New Haven, CT 06520.
| | - Monique Hinchcliff
- Northwestern University Feinberg School of Medicine Department of Medicine 240 E. Huron Street, Suite 1-200 Chicago, IL 60611; Hospital for Special Surgery Department of Medicine, Division of Rheumatology 535 E. 70th Street New York, NY 10021; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Rheumatology 240 E. Huron Street Suite M-300 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Preventive Medicine 680 N. Lake Shore Drive Suite 1400 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine 633 N St. Clair 18th Floor Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Pulmonary and Critical Care Medicine 240 E Huron, McGaw M-300; Northwestern University Feinberg School of Medicine Department of Radiology 251 E. Huron Street, 4th Floor Chicago, IL 60611; hNew York Presbyterian/Weill Cornell Department of Medicine, Division of Pulmonary and Critical Care Medicine 1305 York Ave, 10th floor, Y-1053 New York, NY 10065; Yale School of Medicine Department of Medicine, Section of Rheumatology, Allergy & Immunology The Anlyan Center 300 Cedar Street PO Box 208031 New Haven, CT 06520. Financial support: Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers K23 AR059763 (MH), R01 AR073270 (MH), P60 AR064464 (RWC, KK, JL), and P30 AR072579 (RWC, JL) and National Center for Advancing Translational Sciences-Clinical and Translational Science Award Number UL1 TR000150 (JL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Rheumatology Research Foundation (KS), Scleroderma Foundation (KS), and the Scleroderma Research Foundation (MH) also supported this work. Corresponding author: Monique Hinchcliff, MD MS, Associate Professor of Medicine, Yale School of Medicine, Department of Medicine, Section of Allergy, Rheumatology & Immunology, The Anlyan Center, 300 Cedar Street, PO Box 208031, New Haven, CT 06520.
| |
Collapse
|
13
|
Hurtubise R, Hudson M, Gyger G, Wang M, Steele RJ, Baron M, Hoa S. Association between gastroprotective agents and risk of incident interstitial lung disease in systemic sclerosis. Respir Med 2021; 185:106482. [PMID: 34089970 DOI: 10.1016/j.rmed.2021.106482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Although interstitial lung disease (ILD) occurs in over half of systemic sclerosis (SSc) patients and represents a leading cause of mortality, there are currently no preventative strategies. We evaluated if gastroprotective agents were associated with a lower incident risk of SSc-ILD. METHODS An SSc cohort without clinically apparent ILD at baseline was constructed from the Canadian Scleroderma Research Group registry. The primary exposure was any use of gastroprotective agents. Treatment with promotility agents was assessed as a secondary exposure. Time to development of clinically apparent ILD was compared between exposed and unexposed person-time, using a multivariable marginal structural Cox model incorporating inverse probability of treatment weights to address time-varying confounding. RESULTS In total, 798 subjects met inclusion criteria. At cohort entry, median disease duration was 7.6 (IQR 3.9-15.6) years. During a median 4.4 (IQR 2.6-7.2) years of follow-up, 158 new ILD cases were diagnosed, for a crude incidence of 4.4 (95% CI 3.8-5.1) events per 100 person-years. Most (2085, 73.4%) person-visits were exposed to gastroprotective agents, 579 (20.4%) were exposed to promotility agents, and 554 (19.5%) were exposed to both agents. The marginal structural weighted hazard ratio (HR) for incident ILD related to gastroprotective agents was 0.86 (95% CI 0.52-1.41). When exposure was defined as treatment with promotility agents, the weighted adjusted HR was 0.79 (95% CI: 0.35-1.77). CONCLUSION In this large retrospective cohort study, we were unable to demonstrate a protective role for gastroprotective and promotility agents in preventing clinically apparent SSc-ILD.
Collapse
Affiliation(s)
- Raphaël Hurtubise
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Marie Hudson
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Rheumatology, Jewish General Hospital, Montreal, Quebec, Canada; Lady Davis Institute of Medical Research, Montreal, Quebec, Canada
| | - Geneviève Gyger
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Rheumatology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Mianbo Wang
- Lady Davis Institute of Medical Research, Montreal, Quebec, Canada
| | - Russell J Steele
- Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada
| | - Murray Baron
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Rheumatology, Jewish General Hospital, Montreal, Quebec, Canada; Lady Davis Institute of Medical Research, Montreal, Quebec, Canada
| | - Sabrina Hoa
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada; Division of Rheumatology, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
| |
Collapse
|
14
|
Esophageal dysmotility and lung disease in patients with systemic sclerosis: is there a possible association or correlation? A retrospective chart review. Rheumatol Int 2021; 41:1965-1970. [PMID: 34032895 DOI: 10.1007/s00296-021-04880-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Our aim was to evaluate the relationship between esophageal dysmotility and lung disease by correlating the results of Echocardiogram and Pulmonary Function Test (PFT) with Esophageal Transit Study (ETT). METHODS Charts of Systemic Sclerosis (SSc) patients fulfilling 2013 ACR/EULAR classification criteria seen in Rheumatology clinics were reviewed and their demographics, ETT result, PFT, and echocardiogram data were collected at baseline, years 1, 3, 5, and 10. Patients were divided based on their ETT status and were compared with respect to each variable using a two-sided two-sample t test for continuous variables and a Fisher's exact test for categorical variables. RESULTS 130 patients were identified with either limited cutaneous SSc (109) or diffuse cutaneous SSc (21) with a mean age of 52.65 years. The mean DLCO was statistically worse in abnormal ETT patients [p value = 0.0004] as were the progression rates per year for DLCO at - 2.25 (p value = 0.019). Progression rate of FVC per year was statistically significant in the abnormal ETT group, although the mean value was not. The number of patients with abnormal PASP was not statistically different between the two groups (p values 0.104, 0.178, 0.653 at baseline, years 3 and 5, respectively). CONCLUSION The presence of esophageal dysmotility was associated with increased pulmonary involvement in the form of abnormal DLCO with worsening progression rates per year. There was no statistically significant difference in PASP and FVC between the two groups; however, the progression rate for FVC was worse in adjusted models.
Collapse
|
15
|
Ma L, Zhu Q, Zhang Y, Li J, Jiang Y, Xu D, Zeng X, Hou Y, Liu H. Esophagus involvement in systemic sclerosis: ultrasound parameters and association with clinical manifestations. Arthritis Res Ther 2021; 23:122. [PMID: 33882993 PMCID: PMC8059267 DOI: 10.1186/s13075-021-02505-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background The esophagus involvement in systemic sclerosis (SSc) is very common yet underestimated due to the lack of suitable screening tools. This study aims to explore the usefulness of ultrasound (US) in the assessment of esophagus involvement and to identify its relationship with clinical and CT manifestations. Methods We performed transabdominal esophageal US in 38 SSc patients and 38 controls. US parameters including the abdominal esophagus length, esophagus wall thickness, shear-wave elastography, gastro-esophageal (His) angle, and reflux were compared. Relationships between distinguishable US parameters and clinical/CT parameters, such as gastro-esophageal reflux disease questionnaire (GERDQ), modified Rodnan skin score (mRSS), interstitial lung disease (ILD) score, the largest esophagus diameter (Dmax), and esophagus dilation percentage (%Eop), were evaluated. Results Abdominal esophagus length was shorter in the SSc group than the control group (2.69 cm vs 3.06 cm, P = 0.018), whereas His angle and the angle change before and after drinking water were larger in the SSc group than the control group (121° vs 108°, P < 0.001; 7.97° vs 2.92°, P = 0.025). Reflux was more frequently seen in the SSc group than the control group (7/38 vs 0/38; P = 0.017). As for correlation with clinical and CT parameters, His angle was higher in patients with GERDQ ≥ 8 than GERDQ < 8 (116.5° vs 125.6°, P = 0.035). Patients with reflux showed higher ILD score than patients without (15.8 vs 9.6, P = 0.043). Furthermore, abdominal esophagus length was negatively correlated with %Eop and Dmax (r = − 0.573, P < 0.001; r = − 0.476, P = 0.003). Conclusion US parameters of the esophagus can distinguish SSc patients from controls, as well as have correlations with clinical and CT characteristics. Our pilot study first shows that US can be used as a noninvasive and convenient method to evaluate the esophagus involvement in SSc.
Collapse
Affiliation(s)
- Li Ma
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China
| | - Qingli Zhu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China
| | - Yan Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China
| | - Jianchu Li
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China
| | - Dong Xu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China
| | - Yong Hou
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China.
| | - He Liu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China.
| |
Collapse
|
16
|
Prevalence of Barrett's Esophagus in Female Patients With Scleroderma. Am J Gastroenterol 2021; 116:517-521. [PMID: 33657040 DOI: 10.14309/ajg.0000000000001109] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Systemic sclerosis or scleroderma (SSc) is a chronic autoimmune disease that renders the esophagus prone to significant gastroesophageal reflux due to impaired esophageal clearance and reduced lower esophageal sphincter pressure. The reported prevalence of Barrett's esophagus (BE) in women with SSc varies from 2% to 37% and is derived from older studies with small sample sizes. We aimed to assess the prevalence of BE in a large cohort of women with SSc. METHODS Women with SSc referred from the Mayo Clinic Arizona Rheumatology Clinic who completed esophagogastroduodenoscopy between 2002 and 2020 were included. Demographic and high-resolution manometry data were evaluated. The diagnosis of scleroderma was confirmed by an expert rheumatologist. The BE diagnosis was confirmed by an expert gastrointestinal pathologist. RESULTS There were 235 women with SSc who underwent EGD. High-resolution manometry (HRM) was completed in 172 patients. Women with SSc with BE were significantly more likely to have scleroderma esophagus (absent contractility with hypotensive lower esophageal sphincter) on HRM than women with SSc without BE (P = 0.018). There were 30 patients with SSc (12.8%) with histologically proven BE. Dysplasia was found in 13 (43.3%): 4 with indefinite, 7 with low grade, and 2 with adenocarcinoma. The incidence of any dysplasia was 5.3% per year (0.9% per year for adenocarcinoma). DISCUSSION This the largest study on prevalence of BE in women with SSc, yielding a prevalence of 12.8%. Women with SSc with BE were significantly more likely to have absent contractility with hypotensive lower esophageal sphincter findings on HRM. The high prevalence and incidence of dysplasia found suggest that women with SSc should be included in the screening recommendations for BE.
Collapse
|
17
|
Imaging in Diagnosis of Systemic Sclerosis. J Clin Med 2021; 10:jcm10020248. [PMID: 33445449 PMCID: PMC7827740 DOI: 10.3390/jcm10020248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/28/2020] [Accepted: 01/08/2021] [Indexed: 12/27/2022] Open
Abstract
Systemic sclerosis (SSc) is a connective tissue disease characterized by fibrosis in skin and internal organs, progressive vascular obliteration, and the production of autoantibodies. Diagnostic imaging is irreplaceable in both diagnosing and monitoring patients suffering from systemic sclerosis. In addition to routinely used methods, such as comparative X-ray of the hands or a contrast-enhanced examination of the upper gastrointestinal tract or chest, there is an array of less widespread examinations, with an emphasis on magnetic resonance imaging (MRI) and ultrasonography, not only in the evaluation of the musculoskeletal system. This article will review the various imaging modalities available for SSc imaging and assessment, focusing on their utility as tissue-specific diagnosis and treatment monitoring.
Collapse
|
18
|
Akiyama J, Sumida J, Nakagawa K, Masamune A, Issariyakulkarn N, Patcharatrakul T, Shetler K, Kuribayashi S, Uraoka T, Triadafilopoulos G. New developments in esophageal function testing and esophageal manifestations of connective tissue disorders. Ann N Y Acad Sci 2020; 1481:170-181. [DOI: 10.1111/nyas.14424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/25/2020] [Accepted: 06/09/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Junichi Akiyama
- Division of Gastroenterology and Hepatology National Center for Global Health and Medicine Tokyo Japan
| | - Junko Sumida
- Division of Gastroenterology and Hepatology National Center for Global Health and Medicine Tokyo Japan
| | - Kenichiro Nakagawa
- Division of Gastroenterology Tohoku University Graduate School of Medicine Sendai Japan
| | - Atsushi Masamune
- Division of Gastroenterology Tohoku University Graduate School of Medicine Sendai Japan
| | - Navapan Issariyakulkarn
- Division of Gastroenterology King Chulalongkorn Memorial Hospital Thai Red Cross Society Bangkok Thailand
| | - Tanisa Patcharatrakul
- Division of Gastroenterology King Chulalongkorn Memorial Hospital Thai Red Cross Society Bangkok Thailand
- Center of Excellence in Neurogastroenterology and Motility, Department of Medicine, Faculty of Medicine Chulalongkorn University Bangkok Thailand
| | - Katerina Shetler
- Department of Gastroenterology Palo Alto Medical Foundation Mountain View California
| | - Shiko Kuribayashi
- Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine Maebashi Japan
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine Maebashi Japan
| | - George Triadafilopoulos
- Division of Gastroenterology and Hepatology Stanford University School of Medicine Stanford California
| |
Collapse
|
19
|
Foeldvari I, Klotsche J, Hinrichs B, Helmus N, Kasapcopur O, Adrovic A, Sztajnbok F, Terreri MT, Anton J, Smith V, Katsicas M, Kostik M, Vasquez‐Canizares N, Avcin T, Feldman B, Janarthanan M, Santos MJ, Sawhney S, Schonenberg‐Meinema D, Sifuentes‐Giraldo W, Alexeeva E, Appenzeller S, Battagliotti C, Berntson L, Bica B, Costa Reis P, Eleftheriou D, Kallinich T, Lehman T, Marrani E, Minden K, Nielsen S, Nuruzzaman F, Patwardhan A, Khubchandani R, Stanevicha V, Uziel Y, Torok KS. Under detection of interstitial lung disease in juvenile systemic sclerosis (jSSc). Arthritis Care Res (Hoboken) 2020; 74:364-370. [PMID: 33141441 DOI: 10.1002/acr.24499] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/15/2020] [Accepted: 10/27/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescent Rheumatology Schön Klinik Hamburg Eilbek Hamburg Germany
| | | | - Bernd Hinrichs
- Children's pulmonology, Asklepios Klinik Nord – Heidberg Hamburg Germany
| | - Nicola Helmus
- Hamburg Centre for Pediatric and Adolescent Rheumatology Schön Klinik Hamburg Eilbek Hamburg Germany
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology Cerrahpasa Medical School Istanbul University ‐ Cerrahpasa Istanbul Turkey
| | - Amra Adrovic
- Department of Pediatric Rheumatology Cerrahpasa Medical School Istanbul University ‐ Cerrahpasa Istanbul Turkey
| | | | | | - Jordi Anton
- Pediatric Rheumatology. Hospital Sant Joan de Déu Esplugues (Barcelona) Spain
| | - Vanessa Smith
- Department of Internal Medicine Ghent University Department of Rheumatology Ghent University Hospital Unit for Molecular Immunology and Inflammation VIB Inflammation Research Center (IRC) Ghent Belgium
| | | | - Mikhail Kostik
- Saint‐Petersburg State Pediatric Medical University and Almazov National Medical Research Centre St Petersburg Russian Federation
| | | | - Tadej Avcin
- University Children's Hospital University Medical Center Ljubljana Ljubljana Slovenia
| | - Brian Feldman
- SickKids The Hospital for Sick Children Toronto Canada
| | | | | | | | | | | | - Ekaterina Alexeeva
- National Medical Research Center of Children's Health Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation Moscow Russian Federation
| | - Simone Appenzeller
- School of Medical Science State University of Campinas (UNICAMP) Sao Paulo Brazil
| | | | - Lillemor Berntson
- Dept. of Women’s and Children’s Health Uppsala University Uppsala Sweden
| | - Blanca Bica
- Chefe do Serviço de Reumatologia do Hospital Universitário Clementino Fraga Filho (HUCFF Universidade Federal do Rio de Janeiro Rio de Janeiro Brazil
| | - Patrícia Costa Reis
- Hospital de Santa Maria Faculdade de Medicina Universidade de Lisboa Lisbon Portugal
| | | | - Tilmann Kallinich
- Division of Rheumatology and Clinical Immunology Charité University Medicine Berlin Germany
| | | | | | - Kirsten Minden
- German Rheumatism Research Center Berlin Germany
- Division of Rheumatology and Clinical Immunology Charité University Medicine Berlin Germany
| | | | | | | | | | - Valda Stanevicha
- Riga Stradins University Department of Pediatric University Children Hospital Riga Latvia
| | - Yosef Uziel
- Meir Medical Center Tel Aviv University Kfar Saba Israel
| | | |
Collapse
|
20
|
Kumar A, Sharma A, Agarwal A. CREST syndrome. Postgrad Med J 2020; 97:746. [PMID: 32883767 DOI: 10.1136/postgradmedj-2020-138817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Ashok Kumar
- Rheumatology, Fortis FLT LT Rajan Dhall Hospital, New Delhi, India
| | | | | |
Collapse
|
21
|
Worsening of esophageal dilatation is associated with increase in a high-resolution computed tomography (HRCT) score in early systemic sclerosis-associated interstitial lung disease (SSc-ILD). Clin Rheumatol 2020; 40:955-963. [PMID: 32803568 DOI: 10.1007/s10067-020-05346-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Data regarding longitudinal association between changes (Δ: time2-time1) in the widest esophageal diameter (WED) and Δ HRCT score in early SSc-ILD patients is limited. We therefore investigated the association of ΔWED with Δ HRCT score and predictors of a worse Δ HRCT score in those patients. METHODS We used an inception cohort of early SSc-ILD patients with availability for two HRCT records at enrollment and 1-year follow-up.The extent of ground glass, reticulation, bronchiectasis, and honeycombing was scored and then aggregated to produce a total HRCT score. The WED was measured at four levels and the maximum value was used. The Δ maximum WED, Δ mean WED, and Δ tHRCT score were analyzed. RESULTS We recruited 75 early SSc-ILD patients and found a significant correlation of Δ tHRCT score with a Δ maximum WED (rho = 0.34, p < 0.01) and Δ mean WED (rho = 0.26, p < 0.05). There were 34 patients with a worsening Δ tHRCT (Δ > 0), 17 with stability (Δ = 0), and 24 with improvement (Δ < 0). Patients with a worsening ILD had a significantly shorter disease duration, lower prevalence of tendon friction rub, higher cumulative prednisolone dose, and larger ΔWED than those with stable and improved Δ tHRCT scores. Multivariate ordinal logistic regression identified a larger Δ mean WED (OR 1.21, 95% CI 1.03-1.42, p = 0.02) as a predictor of worsening HRCT score, while presence of tendon friction rub was associated with a lower risk (OR 0.18, 95% CI 0.04-0.77, p = 0.021). CONCLUSION Our study cohort found that a worsening esophageal diameter was a predictor of progression of lung fibrosis determined by HRCT score in early SSc-ILD. A further study regarding esophageal dilation progression different in early versus longstanding SSc-ILD is needed. Key Points •In early SSc-ILD patients, we demonstrated that a worsening esophageal diameter was a predictor of progression of HRCT score at 1-year follow-up. •Further study regarding the association of worsening of the esophageal dilatation with the progression of ILD comparing between early versus late SSc-ILD is needed.
Collapse
|
22
|
Response to the letter by Dr. Costa-Moreira, Dr. Peixoto, Dr. Ramalho, and Dr. Macedo regarding our manuscript: "Relationship between esophageal motility abnormalities and skin or lung involvements in patients with systemic sclerosis". J Gastroenterol 2020; 55:246-247. [PMID: 31549241 DOI: 10.1007/s00535-019-01630-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 09/11/2019] [Indexed: 02/04/2023]
|
23
|
Expression of apoptotic and proliferation factors in gastric mucosa of patients with systemic sclerosis correlates with form of the disease. Sci Rep 2019; 9:18461. [PMID: 31804582 PMCID: PMC6895086 DOI: 10.1038/s41598-019-54988-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 11/22/2019] [Indexed: 02/07/2023] Open
Abstract
Despite high prevalence of patients with gastric disease in systemic sclerosis (SSc), its pathogenesis is still poorly understood. We immunohistochemically analysed biopsies of gastric mucosa (GM) in 5 controls and 15 patients with different forms of SSc: limited cutaneous (lc), diffuse cutaneous moderate (sys1) and severe (sys2). The number of positive cells was analysed by a Kruskall-Wallis test, P < 0.05 was considered statistically significant. Percentage of proliferating (Ki-67 positive) cells was highest in sys1 (3% in superficial and 4,6% in deeper parts of GM), which dropped to 1% in sys2. Percentage of α-smooth muscle actin (α-SMA) positive cells was 5% in controls, 9% in superficial GM, while in deeper GM rose from 7% to 19% in sys1 and sys2, thus indicating increased myofibroblast population. Caspase-3 positive apoptotic cells characterized 1,5–2% of controls, 8% of superficial and 6% of deeper GM cells in sys1. In sys2, apoptosis affected 50% of surface epithelial and gland cells and 30% of deeper glands, and correlated with increased fibrosis and decreased syndecan-1 expression. Our data demonstrate that sys1 is the most „active” proliferating form of SSc. Sys2 characterize collagen deposition, surface epithelium defects, extensive apoptosis and low proliferation, GM atrophy and loss of function.
Collapse
|
24
|
Petcu A, Ghib LJ, Grad SM, Popovici C, Rogojan L, Rednic NV, Rednic S. Upper gastrointestinal involvement in systemic sclerosis: Findings in a real-life setting. Exp Ther Med 2019; 18:5095-5100. [PMID: 31798729 PMCID: PMC6880395 DOI: 10.3892/etm.2019.8125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/01/2019] [Indexed: 12/21/2022] Open
Abstract
Gastrointestinal tract involvement is the most common visceral affectation in systemic sclerosis (SSc), but the manifestations may vary in extension and severity. Endoscopic and histopathological gastroesophageal findings were investigated in patients with SSc. A total of 79 consecutive patients with definite SSc were enrolled in a cross sectional study. Clinical data were collected, upper gastrointestinal endoscopy and biopsies from gastric mucosa were performed in all cases. Fifty-seven (72.1%) out of 79 SSc patients had gastroesophageal symptoms. The most frequent were dysphagia, present in 33 (41.7%) and gastroesophageal reflux symptoms in 23 (29.1%) patients. Out of the 79 patients, 22 were asymptomatic, but in 16 esophageal and gastric mucosa changes were endoscopically detected. Reflux esophagitis was found in 39 (49.3%) patients. The presence of esophageal manifestations was not related to the disease duration or with its other variables. Signs of gastritis were endoscopically described in 47 (59.4%) and confirmed on histopathologic examinations in 45 patients. In 31 patients without any endoscopic changes, 18 (22.7%) showed signs of gastritis on histopathologic examination. No significant statistical differences were found between symptomatic and asymptomatic patients or between those with limited cutaneous SSc and those with diffuse cutaneous SSc in terms of clinical, endoscopic or histopathological findings, except the higher proportion of hiatal hernia in symptomatic patients. The results of this study might suggest that upper gastrointestinal endoscopy should be performed during the early stage of the disease and then periodically in patients diagnosed with SSc, even in the absence of typical symptoms.
Collapse
Affiliation(s)
- Ana Petcu
- Rheumatology Department, ‘Iuliu Haţieganu’ University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Linda Jessica Ghib
- Rheumatology Department, ‘Iuliu Haţieganu’ University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Simona Mihaela Grad
- 2nd Medical Clinic, ‘Iuliu Haţieganu’ University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Cornelia Popovici
- 1st Medical Clinic, Gastroenterology Department, Emergency Clinical County Hospital, 400006 Cluj-Napoca, Romania
| | - Liliana Rogojan
- Department of Pathology, Emergency Clinical County Hospital, 400006 Cluj-Napoca, Romania
| | - Nicolae Voicu Rednic
- 3rd Medical Clinic, Gastroenterology Department, ‘Iuliu Haţieganu’ University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania
| | - Simona Rednic
- Rheumatology Department, ‘Iuliu Haţieganu’ University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| |
Collapse
|
25
|
Kuribayashi S, Motegi SI, Hara K, Shimoyama Y, Hosaka H, Sekiguchi A, Yamaguchi K, Kawamura O, Hisada T, Ishikawa O, Kusano M, Uraoka T. Relationship between esophageal motility abnormalities and skin or lung involvements in patients with systemic sclerosis. J Gastroenterol 2019; 54:950-962. [PMID: 30937625 DOI: 10.1007/s00535-019-01578-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 03/26/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Esophageal motility abnormalities (EMAs) and interstitial lung diseases (ILDs) are often seen in patients with systemic sclerosis (SSc). Gastroesophageal reflux disease (GERD) could be associated with ILDs, but it is not fully understood if ILDs are caused by GERD or SSc itself. METHODS A total of 109 patients with SSc who underwent high-resolution manometry were enrolled. Esophageal motility was diagnosed with the Chicago classification v3.0. The severity of skin thickness was evaluated by the modified Rodnan total skin thickness score (mRSS). The severity of ILDs was assessed with the chest high-resolution computer tomography (HRCT) scoring system. Relationships between EMAs, GERD, autoantibodies, skin thickness and ILDs were evaluated. RESULTS 44 patients had normal esophageal motility, eight had esophago-gastric junction outflow obstruction, one had distal esophageal spasm, 27 had ineffective esophageal motility and 29 had absent contractility (AC). Patients with AC had more GERD than those with normal esophageal motility (p < 0.05). The mRSS score in patients with AC was significantly higher than that in those with normal esophageal motility (p < 0.05). The HRCT score in patients with AC tended to be higher than that in those with normal esophageal motility (p = 0.05). A multivariable analysis showed that severe skin thickness was a significant predictor of AC. GERD was not a significant predictor for ILDs. CONCLUSIONS There were significant correlations between EMAs and severe skin thickness. GERD is not an etiology of ILDs.
Collapse
Affiliation(s)
- Shiko Kuribayashi
- Clinical Investigation and Research Unit, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
- Division of Gastroenterology and Hepatology, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan.
| | - Sei-Ichiro Motegi
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kenichiro Hara
- Allergy and Respiratory Medicine, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
| | - Yasuyuki Shimoyama
- Division of Gastroenterology and Hepatology, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
| | - Hiroko Hosaka
- Division of Gastroenterology and Hepatology, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
| | - Akiko Sekiguchi
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kouichi Yamaguchi
- Allergy and Respiratory Medicine, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
| | - Osamu Kawamura
- Division of Gastroenterology and Hepatology, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
| | - Takeshi Hisada
- Allergy and Respiratory Medicine, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
| | - Osamu Ishikawa
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Motoyasu Kusano
- Division of Gastroenterology and Hepatology, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
| | - Toshio Uraoka
- Division of Gastroenterology and Hepatology, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
| |
Collapse
|
26
|
Ambartsumyan L, Zheng HB, Iyer RS, Soares J, Henstorf G, Stevens AM. Relationship Between Esophageal Abnormalities on Fluoroscopic Esophagram and Pulmonary Function Testing in Juvenile Systemic Sclerosis. Arthritis Care Res (Hoboken) 2019; 71:1444-1449. [DOI: 10.1002/acr.23778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/25/2018] [Indexed: 01/13/2023]
Affiliation(s)
| | | | - Ramesh S. Iyer
- Seattle Children's HospitalUniversity of Washington Seattle
| | | | | | - Anne M. Stevens
- Seattle Children's HospitalUniversity of Washington, and Seattle Children's Research Institute Seattle Washington
| |
Collapse
|
27
|
Tétreault MP, Kahrilas P. GI Manifestations With a Focus on the Esophagus: Recent Progress in Understanding Pathogenesis. Curr Rheumatol Rep 2019; 21:42. [PMID: 31270707 DOI: 10.1007/s11926-019-0841-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Esophageal dysfunction is common in systemic sclerosis (SSc) patients. Limited treatment options are available for scleroderma esophageal disease. Here, we discuss recent updates on the diagnosis, treatment, and characterization that have been made in patients with scleroderma esophageal disease. RECENT FINDINGS In the past few years, novel diagnostic tools have provided insight into esophageal dysmotility in SSc patients. New drugs are being tested and might improve symptoms and quality of life in SSc patients with esophageal dysfunction. Molecular stratification methods have facilitated the identification of molecular signatures in the esophagus of SSc patients. The Friend leukemia integration 1 (Fli1) conditional knockout mouse is the first animal model to report an esophageal phenotype with SSc features. The clinical presentation in SSc patients with esophageal dysfunction is heterogeneous, complicating diagnosis and management. The improvement of diagnostic tools for esophageal symptoms and dysfunction and the use of molecular approaches in SSc mouse models and patient biopsies offer an opportunity to improve the characterization of SSc esophageal disease, which should help improve management and treatment decisions.
Collapse
Affiliation(s)
- Marie-Pier Tétreault
- Department of Medicine, Gastroenterology and Hepatology Division, Northwestern University Feinberg School of Medicine, 15-753 Tarry Building, 300 East Superior Street, Chicago, IL, 60611-3010, USA.
| | - Peter Kahrilas
- Department of Medicine, Gastroenterology and Hepatology Division, Northwestern University Feinberg School of Medicine, 15-753 Tarry Building, 300 East Superior Street, Chicago, IL, 60611-3010, USA
| |
Collapse
|
28
|
Abstract
Purpose of the review Gastroesophageal reflux disease (GERD) is frequently implicated as a cause for respiratory disease. However, there is growing evidence that upper gastrointestinal dysmotility may play a significantly larger role in genesis of respiratory symptoms and development of underlying pulmonary pathology. This paper will discuss the differential diagnosis for esophageal and gastric dysmotility in aerodigestive patients and will review the key diagnostic and therapeutic interventions for this dysmotility. Recent findings Previous studies have shown an association between GERD and pulmonary pathology in children with aerodigestive disorders. Recent publications have demonstrated the presence of esophageal and gastric dysfunction, using fluoroscopic and nuclear medicine studies, in aerodigestive patients who commonly present to pulmonary and otolaryngology clinics. High-resolution impedance manometry (HRIM) has revolutionized our understanding of esophageal dysmotility and its role in pathogenesis of aspiration and esophageal dysfunction and subsequent respiratory compromise. Summary Esophageal and gastric dysmotility have a profound effect on development of respiratory symptoms and pulmonary sequalae in aerodigestive patients. However, our understanding of the pathophysiology is in its infancy. Prospective studies in are needed to address key clinical questions such as: What degree of dysmotility initiates respiratory compromise? What diagnostic tests and therapeutic options best predict aerodigestive outcomes?
Collapse
|
29
|
Bütikofer S, Jordan S, Sauter M, Hollenstein M, Heinrich H, Freitas-Queiroz N, Kuntzen T, Ang D, Oberacher M, Maurer B, Schwizer W, Fox M, Distler O, Misselwitz B. Abnormal esophageal motility during a solid test meal in systemic sclerosis-detection even in very early disease and association with disease progression. Neurogastroenterol Motil 2019; 31:e13480. [PMID: 30276930 DOI: 10.1111/nmo.13480] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 08/10/2018] [Accepted: 09/03/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study assessed whether high-resolution manometry (HRM) with a test meal can detect clinically relevant, abnormal motility already in very early systemic sclerosis (SSc) and whether this finding is associated with subsequent disease progression. METHODS This prospective, longitudinal cohort study recruited 68 consecutive SSc patients (group #1: 32 established disease (ACR, American College of Rheumatology /EULAR, The European League against Rheumatism 2013 and ACR 1980 criteria fulfilled); group #2: 24 early disease (only ACR/EULAR 2013 fulfilled); group #3: 12 very early disease (clinical expert diagnosis of SSc) and 72 healthy controls. HRM evaluated esophageal motility for water swallows and a solid test meal. RESULTS Systemic sclerosis patients had less frequent effective esophageal contractions during the test meal compared to healthy controls even in very early disease (0.15, 1.0, 2.1 per minute for groups #1, #2, and #3, vs 2.5 per minute in health; P < 0.001, P < 0.001, and P < 0.0085, respectively). Ineffective motility at HRM was associated with a higher modified Rodnan skin score at baseline. Moreover, at mean 18 (10-31) months of follow-up, the presence of ineffective motility at baseline was associated with progression of skin disease (P = 0.01). Cox proportional hazard regression analysis identified hypotensive peristalsis in the test meal (<15% effective solid swallows) and low distal contractile integral (DCI; <400 mm Hg·cm·s) as predictors for skin aggravation, but not for new organ involvement. CONCLUSION Ineffective motility during a test meal is present already in patients with very early SSc. Findings on HRM studies are associated with disease severity at baseline, and low percentage of effective swallows in test meal and low mean DCI are both predictors of skin progression during follow-up.
Collapse
Affiliation(s)
- Simon Bütikofer
- Department of Gastroenterology and Hepatology, University Hospital Zurich and Zurich University Switzerland, Zurich, Switzerland
| | - Suzana Jordan
- Department of Rheumatology, University Hospital Zurich and Zurich University, Zurich, Switzerland
| | - Matthias Sauter
- Department of Gastroenterology and Hepatology, University Hospital Zurich and Zurich University Switzerland, Zurich, Switzerland.,Abdominal Center Gastroenterology, Basel, Switzerland
| | - Michael Hollenstein
- Department of Gastroenterology and Hepatology, University Hospital Zurich and Zurich University Switzerland, Zurich, Switzerland
| | - Henriette Heinrich
- Department of Gastroenterology and Hepatology, University Hospital Zurich and Zurich University Switzerland, Zurich, Switzerland.,Abdominal Center Gastroenterology, Basel, Switzerland
| | - Natália Freitas-Queiroz
- Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Thomas Kuntzen
- Department of Gastroenterology and Hepatology, University Hospital Zurich and Zurich University Switzerland, Zurich, Switzerland
| | - Daphne Ang
- Department of Gastroenterology, Changi General Hospital, Singapore
| | - Marcos Oberacher
- Department of Medicine, Spital Limmattal, Schlieren, Switzerland
| | - Britta Maurer
- Department of Rheumatology, University Hospital Zurich and Zurich University, Zurich, Switzerland
| | - Werner Schwizer
- Department of Gastroenterology and Hepatology, University Hospital Zurich and Zurich University Switzerland, Zurich, Switzerland
| | - Mark Fox
- Department of Gastroenterology and Hepatology, University Hospital Zurich and Zurich University Switzerland, Zurich, Switzerland.,Abdominal Center Gastroenterology, Basel, Switzerland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich and Zurich University, Zurich, Switzerland
| | - Benjamin Misselwitz
- Department of Gastroenterology and Hepatology, University Hospital Zurich and Zurich University Switzerland, Zurich, Switzerland
| |
Collapse
|
30
|
Arif T, Adil M, Singh Sodhi J, Hassan I. Assessment of modified Rodnan skin score and esophageal manometry in systemic sclerosis: a study correlating severity of skin and esophageal involvement by objective measures. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2018. [DOI: 10.15570/actaapa.2018.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
31
|
Gyorffy JB, Marowske J, Gancayco J. A Rare Cause of Dysphagia and Weight Loss. Case Rep Gastroenterol 2018; 12:640-645. [PMID: 30483043 PMCID: PMC6244109 DOI: 10.1159/000493919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/17/2018] [Indexed: 11/19/2022] Open
Abstract
Mixed connective tissue disease (MCTD) is a rare connective tissue disorder with clinical features that overlap with systemic lupus erythematous, systemic sclerosis, and polymyositis. We report the case of a patient who presented with dysphagia, 25-lb weight loss, difficulty opening her mouth, and joint pain. Dysphagia workup showed a normal barium swallow and normal-appearing EGD but esophageal manometry consistent with severe dysmotility. Through further laboratory and imaging studies, the patient met the diagnostic criteria for MCTD. She had marked improvement in her dysphagia with steroids, biologic therapy, and intravenous immunoglobulin.
Collapse
Affiliation(s)
- Janelle B Gyorffy
- Department of Internal Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
| | - Johanna Marowske
- Department of Gastroenterology, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
| | - John Gancayco
- Department of Gastroenterology, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
| |
Collapse
|
32
|
Meta-analysis of Gastroesophageal Reflux Disease and Idiopathic Pulmonary Fibrosis. Chest 2018; 155:33-43. [PMID: 30120950 DOI: 10.1016/j.chest.2018.07.038] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/04/2018] [Accepted: 07/09/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The relationship between gastroesophageal reflux disease (GERD) and idiopathic pulmonary fibrosis (IPF) is controversial. Current guidelines recommend that clinicians use regular antacid treatment, while two recent meta-analyses of antacid therapy in IPF were inconclusive. The objective of this study was to examine the evidence regarding the association between GERD and IPF through a systematic review and a meta-analysis, with special reference to the methodologic quality of the observational studies. METHODS The MEDLINE, EMBASE, Ovid, and Web of Science (1966-May 2018) databases were searched for original articles published in any language, and we then systematically reviewed the bibliographies of the retrieved articles. Observational studies (cohort and case-control studies) were selected if they allowed the calculation of a measure of association relating GERD to IPF. RESULTS Eighteen case-control studies including 3,206 patients with IPF and 9,368 control subjects met the inclusion criteria of the meta-analysis. The meta-analysis indicated that GERD is associated with IPF (OR, 2.94 [95% CI, 1.95-4.42]; P homogeneity < .0001). Overall, the results remained consistent whatever the data source (clinical studies vs databases) or the type of control subject (healthy volunteers, patients with respiratory diseases other than interstitial lung disease, or patients with non-IPF interstitial lung disease). In a meta-regression, after controlling for smoking, GERD and IPF were not related. CONCLUSIONS GERD and IPF may be related, but this association is most likely confounded, especially by smoking. Our confidence in the estimate of association is low because it is exclusively from case-control studies. TRIAL REGISTRY PROSPERO; No.: CRD42016053728; URL: http://www.crd.york.ac.uk/PROSPERO.
Collapse
|
33
|
Caron M, Hoa S, Hudson M, Schwartzman K, Steele R. Pulmonary function tests as outcomes for systemic sclerosis interstitial lung disease. Eur Respir Rev 2018; 27:170102. [PMID: 29769294 PMCID: PMC9488607 DOI: 10.1183/16000617.0102-2017] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 02/24/2018] [Indexed: 01/17/2023] Open
Abstract
Interstitial lung disease (ILD) is the leading cause of morbidity and mortality in systemic sclerosis (SSc). We performed a systematic review to characterise the use and validation of pulmonary function tests (PFTs) as surrogate markers for systemic sclerosis-associated interstitial lung disease (SSc-ILD) progression.Five electronic databases were searched to identify all relevant studies. Included studies either used at least one PFT measure as a longitudinal outcome for SSc-ILD progression (i.e. outcome studies) and/or reported at least one classical measure of validity for the PFTs in SSc-ILD (i.e. validation studies).This systematic review included 169 outcome studies and 50 validation studies. Diffusing capacity of the lung for carbon monoxide (DLCO) was cumulatively the most commonly used outcome until 2010 when it was surpassed by forced vital capacity (FVC). FVC (% predicted) was the primary endpoint in 70.4% of studies, compared to 11.3% for % predicted DLCO Only five studies specifically aimed to validate the PFTs: two concluded that DLCO was the best measure of SSc-ILD extent, while the others did not favour any PFT. These studies also showed respectable validity measures for total lung capacity (TLC).Despite the current preference for FVC, available evidence suggests that DLCO and TLC should not yet be discounted as potential surrogate markers for SSc-ILD progression.
Collapse
Affiliation(s)
- Melissa Caron
- Dept of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Sabrina Hoa
- Dept of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Division of Rheumatology, Jewish General Hospital, Montreal, QC, Canada
| | - Marie Hudson
- Division of Rheumatology, Jewish General Hospital, Montreal, QC, Canada
| | - Kevin Schwartzman
- Dept of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Russell Steele
- Dept of Mathematics and Statistics, McGill University, Montreal, QC, Canada
| |
Collapse
|
34
|
Asano Y, Jinnin M, Kawaguchi Y, Kuwana M, Goto D, Sato S, Takehara K, Hatano M, Fujimoto M, Mugii N, Ihn H. Diagnostic criteria, severity classification and guidelines of systemic sclerosis. J Dermatol 2018; 45:633-691. [PMID: 29687465 DOI: 10.1111/1346-8138.14162] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/06/2017] [Indexed: 01/17/2023]
Abstract
Several effective drugs have been identified for the treatment of systemic sclerosis (SSc). However, in advanced cases, not only their effectiveness is reduced but they may be also harmful due to their side-effects. Therefore, early diagnosis and early treatment is most important for the treatment of SSc. We established diagnostic criteria for SSc in 2003 and early diagnostic criteria for SSc in 2011, for the purpose of developing evaluation of each organ in SSc. Moreover, in November 2013, the American College of Rheumatology and the European Rheumatology Association jointly developed new diagnostic criteria for increasing their sensitivity and specificity, so we revised our diagnostic criteria and severity classification of SSc. Furthermore, we have revised the clinical guideline based on the newest evidence. In particular, the clinical guideline was established by clinical questions based on evidence-based medicine according to the New Minds Clinical Practice Guideline Creation Manual (version 1.0). We aimed to make the guideline easy to use and reliable based on the newest evidence, and to present guidance as specific as possible for various clinical problems in treatment of SSc.
Collapse
Affiliation(s)
- Yoshihide Asano
- Department of Dermatology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasushi Kawaguchi
- Institute of Rheumatology, Tokyo Woman's Medical University, Tokyo, Japan
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Daisuke Goto
- Department of Rheumatology, Faculty of Medicine, Univertity of Tsukuba, Ibaraki, Japan
| | - Shinichi Sato
- Department of Dermatology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Takehara
- Department of Molecular Pathology of Skin, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Masaru Hatano
- Graduate School of Medicine Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Tokyo, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Naoki Mugii
- Section of Rehabilitation, Kanazawa University Hospital, Ishikawa, Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| |
Collapse
|
35
|
Lung Involvements in Rheumatic Diseases: Update on the Epidemiology, Pathogenesis, Clinical Features, and Treatment. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6930297. [PMID: 29854780 PMCID: PMC5964428 DOI: 10.1155/2018/6930297] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/27/2018] [Indexed: 01/25/2023]
Abstract
Lung illness encountered in patients with rheumatic diseases bears clinical significance in terms of increased morbidity and mortality as well as potential challenges placed on patient care. Although our understanding of natural history of this important illness is still limited, epidemiologic knowledge has been accumulated during the past decade to provide useful information on the risk factors and prognosis of lung involvements in rheumatic diseases. Moreover, the pathogenesis particularly in the context of genetics has been greatly updated for both the underlying rheumatic disease and associated lung involvement. This review will focus on the current update on the epidemiologic and genetics features and treatment options of the lung involvements associated with four major rheumatic diseases (rheumatoid arthritis, systemic sclerosis, myositis, and systemic lupus erythematosus), with more attention to a specific form of involvement or interstitial lung disease.
Collapse
|
36
|
McFarlane IM, Bhamra MS, Kreps A, Iqbal S, Al-Ani F, Saladini-Aponte C, Grant C, Singh S, Awwal K, Koci K, Saperstein Y, Arroyo-Mercado FM, Laskar DB, Atluri P. Gastrointestinal Manifestations of Systemic Sclerosis. ACTA ACUST UNITED AC 2018; 8. [PMID: 30057856 PMCID: PMC6059963 DOI: 10.4172/2161-1149.1000235] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Systemic sclerosis (SSc) is a rare autoimmune disease characterized by fibroproliferative alterations of the microvasculature leading to fibrosis and loss of function of the skin and internal organs. Gastrointestinal manifestations of SSc are the most commonly encountered complications of the disease affecting nearly 90% of the SSc population. Among these complications, the esophagus and the anorectum are the most commonly affected. However, this devastating disorder does not spare any part of the gastrointestinal tract (GIT), and includes the oral cavity, esophagus, stomach, small and large bowels as well as the liver and pancreas. In this review, we present the current understanding of the pathophysiologic mechanisms of SSc including vasculopathy, endothelial to mesenchymal transformation as well as the autoimmune pathogenetic pathways. We also discuss the clinical presentation and diagnosis of each part of the GIT affected by SSc. Finally, we highlight the latest developments in the management of this disease, addressing the severe malnutrition that affects this vulnerable patient population and ways to assess and improve the nutritional status of the patients.
Collapse
Affiliation(s)
- Isabel M McFarlane
- Division of Rheumatology and Gastroenterology, Department of Medicine and Pathology, Hospitals Kings County Hospital Brooklyn, State University of New York, USA
| | - Manjeet S Bhamra
- Division of Rheumatology and Gastroenterology, Department of Medicine and Pathology, Hospitals Kings County Hospital Brooklyn, State University of New York, USA
| | - Alexandra Kreps
- Division of Rheumatology and Gastroenterology, Department of Medicine and Pathology, Hospitals Kings County Hospital Brooklyn, State University of New York, USA
| | - Sadat Iqbal
- Division of Rheumatology and Gastroenterology, Department of Medicine and Pathology, Hospitals Kings County Hospital Brooklyn, State University of New York, USA
| | - Firas Al-Ani
- Division of Rheumatology and Gastroenterology, Department of Medicine and Pathology, Hospitals Kings County Hospital Brooklyn, State University of New York, USA
| | - Carla Saladini-Aponte
- Division of Rheumatology and Gastroenterology, Department of Medicine and Pathology, Hospitals Kings County Hospital Brooklyn, State University of New York, USA
| | - Christon Grant
- Division of Rheumatology and Gastroenterology, Department of Medicine and Pathology, Hospitals Kings County Hospital Brooklyn, State University of New York, USA
| | - Soberjot Singh
- Division of Rheumatology and Gastroenterology, Department of Medicine and Pathology, Hospitals Kings County Hospital Brooklyn, State University of New York, USA
| | - Khalid Awwal
- Division of Rheumatology and Gastroenterology, Department of Medicine and Pathology, Hospitals Kings County Hospital Brooklyn, State University of New York, USA
| | - Kristaq Koci
- Division of Rheumatology and Gastroenterology, Department of Medicine and Pathology, Hospitals Kings County Hospital Brooklyn, State University of New York, USA
| | - Yair Saperstein
- Division of Rheumatology and Gastroenterology, Department of Medicine and Pathology, Hospitals Kings County Hospital Brooklyn, State University of New York, USA
| | - Fray M Arroyo-Mercado
- Division of Rheumatology and Gastroenterology, Department of Medicine and Pathology, Hospitals Kings County Hospital Brooklyn, State University of New York, USA
| | - Derek B Laskar
- Division of Rheumatology and Gastroenterology, Department of Medicine and Pathology, Hospitals Kings County Hospital Brooklyn, State University of New York, USA
| | - Purna Atluri
- Division of Rheumatology and Gastroenterology, Department of Medicine and Pathology, Hospitals Kings County Hospital Brooklyn, State University of New York, USA
| |
Collapse
|
37
|
Vettori S, Tolone S, Capocotta D, Chieffo R, Giacco V, Valentini G, Docimo L. Esophageal high-resolution impedance manometry alterations in asymptomatic patients with systemic sclerosis: prevalence, associations with disease features, and prognostic value. Clin Rheumatol 2018; 37:1239-1247. [PMID: 29442260 DOI: 10.1007/s10067-018-4026-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/30/2018] [Accepted: 02/02/2018] [Indexed: 12/20/2022]
Abstract
This study aims to investigate pre-clinical esophageal involvement in systemic sclerosis (SSc) by high-resolution impedance manometry (HRiM), its associations with disease features including lung involvement, and its predictivity of esophageal symptoms overtime. Charts of 45 asymptomatic (no heartburn/regurgitation/dysphagia) SSc patients (96% females; mean age 46 years) with at least one follow-up (FU) visit and complete clinical, serological, functional, and radiological assessment, including high-resolution computed tomography (HRCT) of the chest and lung function tests, that had undergone esophageal HRiM were retrospectively evaluated. Esophagogastric junction-contractile integral (EGJ-CI) and esophageal body motility, as evaluated by mean distal contractile integral (DCI), were assessed. SSc patients had a normal esophageal motility in 7/45 cases, a defective EGJ-CI in 28, an ineffective esophageal motility (IEM) in 17, and aperistalsis in 12. Defective EGJ-CI was associated with IEM/aperistalsis in 20 cases, while 9 patients had isolated IEM. Defective EGJ-CI and/or IEM/aperistalsis were associated with a diffusing lung capacity for CO < 80% of predicted value (all p < 0.05), while defective EGJ-CI was also associated with interstitial lung disease on HRCT (p = 0.03). Prevalence of any HRiM abnormality was higher in anti-centromere antibody negative patients (all p < 0.05). IEM/aperistalsis independently increased the risk of esophageal symptoms by 2.3-fold (95% CI 1.1-5.7) and was associated with their higher cumulative incidence with respect to patients with other HRiM patterns at FU (χ2 = 4.63; p = 0.03). SSc patients asymptomatic for esophageal involvement can have HRiM abnormalities in up to 84% of cases. A baseline-impaired motility is a risk factor for symptomatic esophageal disease.
Collapse
Affiliation(s)
- Serena Vettori
- Rheumatology Section, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", c/o II Policlinico, via Pansini 5, 80131, Naples, Italy.
| | - Salvatore Tolone
- Division of General, Mini-Invasive and Bariatric Surgery, Department of Surgery, University of Campania "Luigi Vanvitelli", II Policlinico, Via Pansini 5, 80131, Naples, Italy
| | - Domenico Capocotta
- Rheumatology Section, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", c/o II Policlinico, via Pansini 5, 80131, Naples, Italy
| | - Rossella Chieffo
- Rheumatology Section, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", c/o II Policlinico, via Pansini 5, 80131, Naples, Italy
| | - Veronica Giacco
- Rheumatology Section, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", c/o II Policlinico, via Pansini 5, 80131, Naples, Italy
| | - Gabriele Valentini
- Rheumatology Section, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", c/o II Policlinico, via Pansini 5, 80131, Naples, Italy
| | - Ludovico Docimo
- Division of General, Mini-Invasive and Bariatric Surgery, Department of Surgery, University of Campania "Luigi Vanvitelli", II Policlinico, Via Pansini 5, 80131, Naples, Italy
| |
Collapse
|
38
|
Sánchez-Cano D, Ortego-Centeno N, Callejas JL, Fonollosa Plá V, Ríos-Fernández R, Tolosa-Vilella C, Espinosa-Garriga G, Colunga-Argüelles D, Egurbide-Arberas MV, Rubio-Rivas M, Freire M, Ríos-Blanco JJ, Trapiella-Martínez L, Rodríguez-Carballeira M, Marín-Ballvé A, Pla-Salas X, Simeón-Aznar CP. Interstitial lung disease in systemic sclerosis: data from the spanish scleroderma study group. Rheumatol Int 2018; 38:363-374. [PMID: 29322341 DOI: 10.1007/s00296-017-3916-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/15/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To evaluate the clinical characteristics of patients with interstitial lung disease (ILD) in the setting of a large cohort of systemic sclerosis (SSc) patients, and to analyse the differences according to the SSc subtype (following the modification of classification criteria of the American College of Rheumatology for SSc proposed by LeRoy and Medsger), factors are associated with moderate-to-severe impairment of lung function, as well as mortality and causes of death. METHODS A descriptive study was performed, using the available data from the Spanish Scleroderma Study Group. RESULTS Twenty-one referral centers participated in the registry. By April 2014, 1374 patients with SSc had been enrolled, and 595 of whom (43%) had ILD: 316 (53%) with limited cutaneous SSc (lcSSc), 240 (40%) with diffuse cutaneous SSc (dcSSc), and 39 (7%) with SSc sine scleroderma (ssSSc). ILD in the lcSSc and the ssSSc subsets tended to develop later, and showed a less impaired forced vital capacity (FVC) and a ground glass pattern on high-resolution computed tomography (HRCT) less frequently, compared with the dcSSc subset. Factors related to an FVC < 70% of predicted in the multivariate analysis were: dcSSc, positivity to anti-topoisomerase I antibodies, a ground glass pattern on HCRT, an active nailfold capillaroscopy pattern, lower DLco, older age at symptoms onset, and longer time between symptoms onset and ILD diagnosis. Finally, SSc-associated mortality and ILD-related mortality were highest in dcSSc patients, whereas that related to pulmonary arterial hypertension was highest in those with lcSSc-associated ILD. CONCLUSIONS Our study indicates that ILD constitutes a remarkable complication of SSc with significant morbidity and mortality, which should be borne in mind in all three subgroups (lcSSc, dcSSc, and ssSSc).
Collapse
Affiliation(s)
- D Sánchez-Cano
- Systemic Autoimmune Diseases Unit, Hospital Universitario San Cecilio, 18016, Granada, Spain
| | - N Ortego-Centeno
- Systemic Autoimmune Diseases Unit, Hospital Universitario San Cecilio, 18016, Granada, Spain.
| | - J L Callejas
- Systemic Autoimmune Diseases Unit, Hospital Universitario San Cecilio, 18016, Granada, Spain
| | - V Fonollosa Plá
- Internal Medicine Department, Hospital VallD'Hebron, 08035, Barcelona, Spain
| | - R Ríos-Fernández
- Systemic Autoimmune Diseases Unit, Hospital Universitario San Cecilio, 18016, Granada, Spain
| | - C Tolosa-Vilella
- Internal Medicine Department, Corporación Sanitaria Universitaria ParcTaulí, 08208, Sabadell, Barcelona, Spain
| | - G Espinosa-Garriga
- Department of Autoimmune Diseases, Institut Clinic de Medicina I Dermatologia, Hospital Clinic, 08036, Barcelona, Spain
| | - D Colunga-Argüelles
- Internal Medicine Department, Hospital Universitario Central de Asturias, 33011, Oviedo, Asturias, Spain
| | - M V Egurbide-Arberas
- Internal Medicine Department, Hospital de Cruces, 48903, Barakaldo, Vizcaya, Spain
| | - M Rubio-Rivas
- Internal Medicine Department, Hospital Universitario de Bellvitge, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Freire
- Internal Medicine Department, Complejo Hospitalario Universitario de Vigo, 36312, Vigo, Pontevedra, Spain
| | - J J Ríos-Blanco
- Internal Medicine Department, Hospital La Paz, 28046, Madrid, Spain
| | - L Trapiella-Martínez
- Internal Medicine Department, Hospital de Cabueñes, 33394, Gijón, Asturias, Spain
| | | | - A Marín-Ballvé
- Internal Medicine Department, Hospital Clínico Universitario Lozano Blesa, 50009, Zaragoza, Spain
| | - X Pla-Salas
- Internal Medicine Department, Consorci Hospitalari de Vic, 08500, Barcelona, Spain
| | - C P Simeón-Aznar
- Internal Medicine Department, Hospital VallD'Hebron, 08035, Barcelona, Spain.,Internal Medicine Department, Corporación Sanitaria Universitaria ParcTaulí, 08208, Sabadell, Barcelona, Spain
| |
Collapse
|
39
|
Fynne L, Liao D, Aksglaede K, Lottrup C, Gregersen H, Bjerregaard NC, Drewes AM, Krogh K. Esophagogastric junction in systemic sclerosis: A study with the functional lumen imaging probe. Neurogastroenterol Motil 2017; 29. [PMID: 28466556 DOI: 10.1111/nmo.13073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 02/24/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Fibrosis and atrophy of esophageal smooth muscle cells cause gastro-esophageal reflux and dysphagia in most patients with systemic sclerosis (SSc). Recent studies indicate that distensibility of the esophagogastric junction (EGJ), assessed with the Functional Lumen Imaging Probe (FLIP) may be a more sensitive and accurate measure of sphincter function than manometry. We aim to describe and compare distension parameters of the EGJ in a well-characterized group of patients with SSc. METHOD Twelve patients with SSc reporting reflux or dysphagia (11 women, median age 53 [range 35-72], duration of disease: 1-20 years) were investigated using distensibility testing of the EGJ. Patients were compared with 11 healthy volunteers (HV) (10 women, median age 53 [range 40-68]). The pressure and minimum diameter along the EGJ during ramp distension were used for distensibility analysis. KEY RESULTS Patients with SSc had significantly lower EGJ yield pressure (median: 4.0 mm Hg [Inter Quartile Range (IQR): 2.8-7.7]) than HV (median: 6.2 mm Hg [IQR: 9.4-26]) (P=.007). Likewise, the pressure-strain elastic modulus was lower in SSc patients (median 1.73 kPa [IQR: 1.16-2.15]) than in HV (median 2.41 kPa [IQR: 1.85-2.67]) (P=.03), indicating the reduced resistance to distension in SSc patient. CONCLUSION & INFERENCES Patients with SSc and symptoms of reflux and dysphagia have significantly reduced resistance to distension of the EGJ.
Collapse
Affiliation(s)
- L Fynne
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - D Liao
- GIOME Academia, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - K Aksglaede
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - C Lottrup
- Mech-Sense, Department of Gastroenterology and Hepatology & Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - H Gregersen
- GIOME, Department of Surgery, Prince of Wales Hospital and Chinese University of Hong Kong, Shatin, Hong Kong
| | - N C Bjerregaard
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - A M Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology & Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - K Krogh
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
40
|
Association between Clinical Manifestations of Systemic Sclerosis and Esophageal Dysmotility Assessed by High-Resolution Manometry. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2017. [DOI: 10.5301/jsrd.5000233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose To characterize esophageal involvement according to high-resolution manometry (HRM) findings using the 3rd version of the Chicago Classification, in a French population of patients fulfilling the ACR/EULAR 2013 classification criteria for systemic sclerosis (SSc). Methods Thirty-six patients were consecutively included in this cross-sectional non-interventional study and had HRM performed in Rennes University hospital. Demographic and clinical characteristics, SSc history and interstitial lung disease (ILD) on CT-scan were assessed, and compared with esophageal motility. Results Sixty-one percent of SSc patients had ineffective peristalsis (55.6% failed peristalsis and 5.6% weak peristalsis), 33.3% had hypotensive esophagogastric junction pressure, 75% did not have a physiologic contraction following multiple rapid swallow (MRS), and 44.4% had an abnormal peristaltic reserve. One patient had type 1 achalasia and another one had Jackhammer esophagus. Failed peristalsis was associated with pyrosis (odds ratio [OR] 7.28, 95% confidence interval [CI] 1.51-35.21, p = 0.009), a higher modified Rodnan skin score (MRSS) (without failed peristalsis: 4.68 ± 2.95 vs. with failed peristalsis: 10.68 ± 9.23; p<0.05), the presence of telangiectasia (OR 7, 95% CI 1.59-30.8, p = 0.007), and low diffusing capacity of the lung for carbon monoxide (DLCO) (p = 0.013). Food in the esophagus and esophageal dilation on CT-scan were associated with failed contractions on HRM (respectively, OR 6.85, 95% CI 1.12-40.82, p = 0.05, and OR 14.67, CI 2.4-88.5, p = 0.002). Conclusions This study confirms that failed peristalsis is frequent in SSc and associated with other organ involvement. We found a concordance between HRM results and CT-scan findings regarding esophageal involvement.
Collapse
|
41
|
Roca F, Dominique S, Schmidt J, Smail A, Duhaut P, Lévesque H, Marie I. Interstitial lung disease in primary Sjögren's syndrome. Autoimmun Rev 2017; 16:48-54. [DOI: 10.1016/j.autrev.2016.09.017] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/08/2016] [Indexed: 12/21/2022]
|
42
|
Marie I, Leroi AM, Gourcerol G, Levesque H, Menard JF, Ducrotte P. Lactose malabsorption in systemic sclerosis. Aliment Pharmacol Ther 2016; 44:1123-1133. [PMID: 27677253 DOI: 10.1111/apt.13810] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 08/01/2016] [Accepted: 09/05/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND There are no studies on systemic sclerosis (SSc) assessing the relationship between food intake, especially lactose, and gastrointestinal dysfunction. AIM To determine the prevalence of lactose malabsorption, using lactose breath test, in patients with SSc. To evaluate the correlation between lactose malabsorption and gastrointestinal involvement. To predict which SSc patients exhibit lactose malabsorption. METHODS Seventy-seven consecutive Caucasian patients with SSc and 20 control subjects underwent lactose breath test. All patients also completed a questionnaire on digestive symptoms, and a global symptom score (GSS) was calculated. RESULTS The prevalence of lactose malabsorption was higher in SSc patients than in controls (44.3% vs. 10%; P = 0.004). We observed a marked correlation between the presence of lactose malabsorption and: higher values of GSS (P < 0.0001); severe oesophageal (P = 0.018) and small intestinal (P = 0.04) motor disorders; and joint involvement (P = 0.019). Furthermore, in SSc patients with symptomatic lactose malabsorption, the median value of GSS of digestive symptoms was lower after initiation of lactose-free diet (P < 0.0001). CONCLUSIONS Our study underscores the fact that lactose malabsorption often occurs in patients with systemic sclerosis. Furthermore, our findings highlight the fact that lactose breath test is a helpful, noninvasive method, by identifying the group of patients with systemic sclerosis with symptomatic lactose malabsorption that may benefit from a reduction in lactose intake.
Collapse
Affiliation(s)
- I Marie
- Department of Internal Medicine, Rouen University Hospital, and INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France.
| | - A-M Leroi
- Department of Digestive Physiology, Rouen University Hospital, and INSERM UMR 1073, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France
| | - G Gourcerol
- Department of Digestive Physiology, Rouen University Hospital, and INSERM UMR 1073, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France
| | - H Levesque
- Department of Internal Medicine, Rouen University Hospital, and INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France
| | - J-F Menard
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - P Ducrotte
- Department of Gastroenterology, Rouen University Hospital, and INSERM UMR 1073, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France
| |
Collapse
|
43
|
Abstract
In patients with systemic sclerosis (SSc), gastrointestinal (GI) tract involvement is almost universal. Any segment of the GI tract from mouth to anus can be involved, and GI symptoms are a frequent cause of morbidity. In severe cases, GI tract involvement can progress to the point of malnutrition requiring parenteral nutrition. GI tract involvement in SSc contributes to disease-related mortality although mostly as a co-morbidity rather than direct cause of death. The review is intended to help address challenges in the assessment and treatment of GI tract involvement in SSc.
Collapse
|
44
|
Adegunsoye A, Strek ME, Garrity E, Guzy R, Bag R. Comprehensive Care of the Lung Transplant Patient. Chest 2016; 152:150-164. [PMID: 27729262 DOI: 10.1016/j.chest.2016.10.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/27/2016] [Accepted: 10/01/2016] [Indexed: 12/20/2022] Open
Abstract
Lung transplantation has evolved into a life-saving treatment with improved quality of life for patients with end-stage respiratory failure unresponsive to other medical or surgical interventions. With improving survival rates, the number of lung transplant recipients with preexisting and posttransplant comorbidities that require attention continues to increase. A partnership between transplant and nontransplant care providers is necessary to deliver comprehensive and optimal care for transplant candidates and recipients. The goals of this partnership include timely referral and assistance with transplant evaluation, optimization of comorbidities and preparation for transplantation, management of common posttransplant medical comorbidities, immunization, screening for malignancy, and counseling for a healthy lifestyle to maximize the likelihood of a good outcome. We aim to provide an outline of the main aspects of the care of candidates for and recipients of lung transplants for nontransplant physicians and other care providers.
Collapse
Affiliation(s)
- Ayodeji Adegunsoye
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL
| | - Mary E Strek
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL
| | - Edward Garrity
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL; Lung Transplant Program, University of Chicago, Chicago, IL
| | - Robert Guzy
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL; Lung Transplant Program, University of Chicago, Chicago, IL
| | - Remzi Bag
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL; Lung Transplant Program, University of Chicago, Chicago, IL.
| |
Collapse
|
45
|
Furnari M, Savarino V, de Bortoli N, Savarino E. Interstitial lung disease in systemic sclerosis patients may benefit more from anti-reflux therapies than from immunosuppressants. Autoimmun Rev 2016; 15:1208-1209. [PMID: 27666817 DOI: 10.1016/j.autrev.2016.09.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Manuele Furnari
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy.
| | - Vincenzo Savarino
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Nicola de Bortoli
- Gastroenterology Unit, Department of Internal Medicine, University of Pisa, Pisa, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| |
Collapse
|
46
|
Furnari M, Savarino V, Savarino E. Fecal calprotectin in systemic sclerosis: Light and shade of a promising tool. Autoimmun Rev 2016; 15:1206-1207. [PMID: 27666812 DOI: 10.1016/j.autrev.2016.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Manuele Furnari
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy.
| | - Vincenzo Savarino
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| |
Collapse
|
47
|
Takekoshi D, Arami S, Sheppard TJ, Cole-Saffold P, Michel JC, Kondos GT, Schraufnagel DE. Computed Tomography of the Esophagus in Scleroderma and Lung Disease. TOHOKU J EXP MED 2016; 237:345-52. [PMID: 26639310 DOI: 10.1620/tjem.237.345] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Systemic sclerosis, or scleroderma, is a collagen vascular disease characterized by hardening of the skin and involvement of internal organs, most commonly the esophagus. The most frequent cause of death in these patients is lung disease. Esophageal dysfunction has been implicated in the pathogenesis of interstitial lung disease. We previously developed a standard for the esophageal diameter on chest computed tomography (CT) and hypothesized that patients with esophageal dilation would be more likely to have interstitial lung disease than those without. In this study, we test this in 121 systemic sclerosis patients with interstitial lung disease and 48 of those without interstitial lung disease. For controls, we evaluated 121 patients followed at a general pulmonary clinic and the previously studied normal healthy standards. This study demonstrated that esophageal dilation is common in systemic sclerosis patients (66.3% for the maximal esophageal diameter more than or equal to 15 mm), that systemic sclerosis patients with interstitial lung disease have more dilated esophagi than those without interstitial lung disease (median 19.4 mm vs. 14.1 mm), and that esophageal parameters are negatively correlated with pulmonary function. We also found that patients from general pulmonary clinic were more likely to have dilated esophagi than normal controls (median 12.1 mm vs. 9.7 mm). The CT measurement of esophageal diameter may be a useful marker of patients at risk for developing lung disease.
Collapse
Affiliation(s)
- Daisuke Takekoshi
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago
| | | | | | | | | | | | | |
Collapse
|
48
|
Kimmel JN, Carlson DA, Hinchcliff M, Carns MA, Aren KA, Lee J, Pandolfino JE. The association between systemic sclerosis disease manifestations and esophageal high-resolution manometry parameters. Neurogastroenterol Motil 2016; 28:1157-65. [PMID: 26921101 PMCID: PMC4956560 DOI: 10.1111/nmo.12813] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 02/03/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND We aimed to evaluate the associations between systemic sclerosis (SSc)-related systemic manifestations and esophageal function using high-resolution manometry (HRM). METHODS Patients with SSc that had undergone HRM between 1/2004 and 9/2014 were identified and HRMs were analyzed according to the Chicago Classification. Clinical characteristics were identified via retrospective chart review and compared among motility diagnoses while adjusting for age, gender, race, and SSc-disease duration. KEY RESULTS Seventy-nine patients (85% female, ages 25-77) were included. Clinical characteristics were compared between patients with absent contractility (AC, n = 40), ineffective esophageal motility (IEM; n = 15), and normal motility (n = 19); the five remaining patients met criteria for other motility diagnoses. Groups differed in severity of skin involvement measured by the modified Rodnan skin score (0-51): AC (adjusted mean 12.6), IEM (4.4), normal (4.3), p = 0.043. Pulmonary function tests [percent predicted FVC and DLCO) were lower in AC (adjusted mean, FVC: 70.3, DLCO 51.1), than IEM (FVC: 92.0; DLCO: 76.9) and normal motility (FVC: 80.0; DLCO: 67.2), p values 0.057 (FVC) and 0.007 (DLCO). Groups did not differ by SSc-disease duration, autoantibodies, or reported symptoms of dysphagia or reflux. CONCLUSIONS & INFERENCES In patients with SSc, absent esophageal contractility on HRM was associated with increased skin disease severity and worse lung function. Obtaining HRM to identify SSc patients with more severe esophageal dysfunction could be considered to enable implementation of management strategies in patients potentially at risk for increased morbidity and mortality.
Collapse
Affiliation(s)
- Jessica N. Kimmel
- Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dustin A. Carlson
- Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Monique Hinchcliff
- Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mary A. Carns
- Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kathleen A Aren
- Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jungwha Lee
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - John E. Pandolfino
- Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
49
|
Wood RK. Esophageal Dysmotility, Gastro-esophageal Reflux Disease, and Lung Transplantation: What Is the Evidence? Curr Gastroenterol Rep 2016; 17:48. [PMID: 26454656 DOI: 10.1007/s11894-015-0474-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Lung transplantation is an effective and life-prolonging therapy for patients with advanced lung disease (ALD). However, long-term patient survival following lung transplantation is primarily limited by development of an inflammatory and fibrotic process involving the lung allograft known as bronchiolitis obliterans syndrome (BOS). Although the precise cause of BOS remains uncertain and is likely multifactorial, chronic aspiration of gastro-duodenal contents is one possible contributing factor. Multiple small, cross-sectional studies performed over the past two decades have reported a high prevalence of gastro-esophageal reflux disease (GERD) and esophageal dysmotility in the ALD population and several investigations suggest the prevalence may increase following lung transplantation. More recent studies evaluating the direct effect of gastro-duodenal contents on airways have demonstrated a possible biologic link between GERD and BOS. Despite the recent advances in our understanding of BOS, further investigations are needed to establish GERD as a causative factor in its development. This review will discuss the existing literature that has identified an association of GERD with ALD and post-transplant populations, with a focus on recent advances in the field.
Collapse
Affiliation(s)
- Richard K Wood
- Division of Gastroenterology, Duke University Medical Center, DUMC 3662, Durham, NC, 27710, USA.
| |
Collapse
|
50
|
Demoruelle MK, Mittoo S, Solomon JJ. Connective tissue disease-related interstitial lung disease. Best Pract Res Clin Rheumatol 2016; 30:39-52. [PMID: 27421215 DOI: 10.1016/j.berh.2016.04.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/10/2016] [Accepted: 04/11/2016] [Indexed: 02/08/2023]
Abstract
Interstitial lung disease (ILD) is commonly present in patients with an underlying connective tissue disease (CTD), particularly those with systemic sclerosis, rheumatoid arthritis, and inflammatory myositis. The clinical spectrum can range from asymptomatic findings on imaging to respiratory failure and death. Distinguishing features in the clinical, radiographic, and histopathologic characteristics of CTD-ILD subsets can predict prognosis and treatment response. Treatment often consists of combinations of immunosuppressive medications, but there is a paucity of guidance in the literature to help clinicians determine appropriate screening and management of CTD-ILD. As such, there is a critical need for studies that can elucidate the natural history of the CTD-ILD, as well as clarify optimal therapies for CTD patients with ILD.
Collapse
Affiliation(s)
| | - Shikha Mittoo
- University of Toronto, Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Joshua J Solomon
- National Jewish Health, Division of Pulmonary and Critical Care Medicine, Denver, CO, USA.
| |
Collapse
|