OBJECTIVES: Interstitial lung disease (ILD) is currently the main cause of death in systemic sclerosis (SSc) and has an unknown pathogenesis. Gastroesophageal reflux (GER) has been strongly implicated as a cause of ILD in several lung diseases, including SSc-ILD. This review summarizes clinical, radiologic, histopathologic, and treatment aspects of GER in SSc-ILD. METHODS: The PubMed database was searched using the following keywords: "systemic sclerosis, scleroderma, interstitial lung disease, and gastroesophageal reflux." The research was limited to English-language studies that included SSc patients with ILD. RESULTS: Pulmonary function tests were related with the presence of GER in several esophageal functional tests (esophageal endoscopy, pH monitoring, and manometric analysis). Regarding the histopathologic data, a pattern called centrilobular fibrosis was described in 21% of 28 lung biopsies, with a bronchocentric distribution and with an intraluminal content resembling gastric fluid. Radiologic evidence of esophageal dilation is very frequent in SSc patients, and consolidation with a patchy distribution was almost exclusively found in SSc patients with centrilobular fibrosis lung pattern. Furthermore, high levels of serum KL-6, a marker of epithelial injury, are indicative of active ILD in SSc disease. CONCLUSIONS: The association of GER with SSc-ILD is strongly supported by several studies. An aggressive treatment for reflux is recommended in all SSc patients with ILD; however, future studies need to be performed to prove a long-term benefit.
OBJECTIVES:Interstitial lung disease (ILD) is currently the main cause of death in systemic sclerosis (SSc) and has an unknown pathogenesis. Gastroesophageal reflux (GER) has been strongly implicated as a cause of ILD in several lung diseases, including SSc-ILD. This review summarizes clinical, radiologic, histopathologic, and treatment aspects of GER in SSc-ILD. METHODS: The PubMed database was searched using the following keywords: "systemic sclerosis, scleroderma, interstitial lung disease, and gastroesophageal reflux." The research was limited to English-language studies that included SSc patients with ILD. RESULTS: Pulmonary function tests were related with the presence of GER in several esophageal functional tests (esophageal endoscopy, pH monitoring, and manometric analysis). Regarding the histopathologic data, a pattern called centrilobular fibrosis was described in 21% of 28 lung biopsies, with a bronchocentric distribution and with an intraluminal content resembling gastric fluid. Radiologic evidence of esophageal dilation is very frequent in SSc patients, and consolidation with a patchy distribution was almost exclusively found in SSc patients with centrilobular fibrosis lung pattern. Furthermore, high levels of serum KL-6, a marker of epithelial injury, are indicative of active ILD in SSc disease. CONCLUSIONS: The association of GER with SSc-ILD is strongly supported by several studies. An aggressive treatment for reflux is recommended in all SSc patients with ILD; however, future studies need to be performed to prove a long-term benefit.
Authors: J N Kimmel; D A Carlson; M Hinchcliff; M A Carns; K A Aren; J Lee; J E Pandolfino Journal: Neurogastroenterol Motil Date: 2016-02-27 Impact factor: 3.598
Authors: D Sánchez-Cano; N Ortego-Centeno; J L Callejas; V Fonollosa Plá; R Ríos-Fernández; C Tolosa-Vilella; G Espinosa-Garriga; D Colunga-Argüelles; M V Egurbide-Arberas; M Rubio-Rivas; M Freire; J J Ríos-Blanco; L Trapiella-Martínez; M Rodríguez-Carballeira; A Marín-Ballvé; X Pla-Salas; C P Simeón-Aznar Journal: Rheumatol Int Date: 2018-01-10 Impact factor: 2.631
Authors: E K Stern; D A Carlson; S Falmagne; A D Hoffmann; M Carns; J E Pandolfino; M Hinchcliff; D M Brenner Journal: Neurogastroenterol Motil Date: 2017-11-06 Impact factor: 3.598