Carrie Richardson1, Rishi Agrawal2, Jungwha Lee3, Orit Almagor4, Ryan Nelson5, John Varga4, Michael J Cuttica6, Jane D Amico Dematte6, Rowland W Chang7, Monique E Hinchcliff8. 1. Department of Medicine, McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Medicine, Division of Rheumatology, Johns Hopkins University, Baltimore, MD. 2. Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL. 3. Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. 4. Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, 240 E Huron St, Suite M-300, Chicago, IL 60611. 5. Department of Medicine, McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, IL. 6. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. 7. Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, 240 E Huron St, Suite M-300, Chicago, IL 60611; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. 8. Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, 240 E Huron St, Suite M-300, Chicago, IL 60611. Electronic address: m-hinchcliff@northwestern.edu.
Abstract
OBJECTIVE: A patulous esophagus on high-resolution computed tomography (HRCT) of the thorax is frequently observed in patients with systemic sclerosis (SSc). Microaspiration has been purported to play a role in the development and progression of SSc interstitial lung disease (ILD), but studies examining the role of microaspiration in SSc ILD have yielded conflicting results. This study was conducted to determine the association between esophageal diameter and SSc ILD. METHODS: A cross-sectional study of Northwestern Scleroderma Registry patients with available HRCT exams was conducted. The predictor variable was the widest esophageal diameter (WED) on HRCT, and the primary and secondary outcome variables were radiographic ILD and pulmonary function tests respectively. The degree of radiographic ILD was assessed using a semi-quantitative score adapted from published methods. Estimated regression coefficients adjusted for age, sex, race, body mass index, smoking; SSc disease subtype, serum autoantibodies, and disease duration; modified Rodnan skin score, proton pump inhibitor, and immune suppressant medication use and erythrocyte sedimentation rate were calculated. RESULTS: A total of 270 subjects were studied. In the adjusted analyses, there were positive associations between WED and total ILD score (β = 0.27; 95% CI: 0.09-0.41), fibrosis (β = 0.15; 95% CI: 0.07-0.23), and ground glass opacities (β = 0.12; 95% CI: 0.04-0.20); there were negative associations between WED and FVC % predicted (β = -0.42; 95% CI: -0.69 to -0.13), and adjusted DLCO % predicted (β = -0.45; 95% CI: -0.80 to -0.09) after adjusting for potential confounders. CONCLUSIONS: Increasing esophageal diameter on HRCT in patients with SSc is associated with more severe radiographic ILD, lower lung volumes, and lower DLCO % predicted. Longitudinal studies are needed to determine if esophageal dilatation is associated with the incidence and/or progression of ILD in patients with SSc.
OBJECTIVE: A patulous esophagus on high-resolution computed tomography (HRCT) of the thorax is frequently observed in patients with systemic sclerosis (SSc). Microaspiration has been purported to play a role in the development and progression of SSc interstitial lung disease (ILD), but studies examining the role of microaspiration in SSc ILD have yielded conflicting results. This study was conducted to determine the association between esophageal diameter and SSc ILD. METHODS: A cross-sectional study of Northwestern Scleroderma Registry patients with available HRCT exams was conducted. The predictor variable was the widest esophageal diameter (WED) on HRCT, and the primary and secondary outcome variables were radiographic ILD and pulmonary function tests respectively. The degree of radiographic ILD was assessed using a semi-quantitative score adapted from published methods. Estimated regression coefficients adjusted for age, sex, race, body mass index, smoking; SSc disease subtype, serum autoantibodies, and disease duration; modified Rodnan skin score, proton pump inhibitor, and immune suppressant medication use and erythrocyte sedimentation rate were calculated. RESULTS: A total of 270 subjects were studied. In the adjusted analyses, there were positive associations between WED and total ILD score (β = 0.27; 95% CI: 0.09-0.41), fibrosis (β = 0.15; 95% CI: 0.07-0.23), and ground glass opacities (β = 0.12; 95% CI: 0.04-0.20); there were negative associations between WED and FVC % predicted (β = -0.42; 95% CI: -0.69 to -0.13), and adjusted DLCO % predicted (β = -0.45; 95% CI: -0.80 to -0.09) after adjusting for potential confounders. CONCLUSIONS: Increasing esophageal diameter on HRCT in patients with SSc is associated with more severe radiographic ILD, lower lung volumes, and lower DLCO % predicted. Longitudinal studies are needed to determine if esophageal dilatation is associated with the incidence and/or progression of ILD in patients with SSc.
Authors: Frank van den Hoogen; Dinesh Khanna; Jaap Fransen; Sindhu R Johnson; Murray Baron; Alan Tyndall; Marco Matucci-Cerinic; Raymond P Naden; Thomas A Medsger; Patricia E Carreira; Gabriela Riemekasten; Philip J Clements; Christopher P Denton; Oliver Distler; Yannick Allanore; Daniel E Furst; Armando Gabrielli; Maureen D Mayes; Jacob M van Laar; James R Seibold; Laszlo Czirjak; Virginia D Steen; Murat Inanc; Otylia Kowal-Bielecka; Ulf Müller-Ladner; Gabriele Valentini; Douglas J Veale; Madelon C Vonk; Ulrich A Walker; Lorinda Chung; David H Collier; Mary Ellen Csuka; Barri J Fessler; Serena Guiducci; Ariane Herrick; Vivien M Hsu; Sergio Jimenez; Bashar Kahaleh; Peter A Merkel; Stanislav Sierakowski; Richard M Silver; Robert W Simms; John Varga; Janet E Pope Journal: Arthritis Rheum Date: 2013-10-03
Authors: Joyce S Lee; Jay H Ryu; Brett M Elicker; Carmen P Lydell; Kirk D Jones; Paul J Wolters; Talmadge E King; Harold R Collard Journal: Am J Respir Crit Care Med Date: 2011-06-23 Impact factor: 21.405
Authors: E H Pitrez; M Bredemeier; R M Xavier; K G Capobianco; V G Restelli; M V Vieira; D H C Ludwig; J C T Brenol; A P A Furtado; L M B Fonseca; B Gutfilen Journal: Br J Radiol Date: 2006-08-02 Impact factor: 3.039
Authors: M C Vonk; C E van Die; M M Snoeren; K J Bhansing; P L C M van Riel; J Fransen; F H J van den Hoogen Journal: Ann Rheum Dis Date: 2007-12-28 Impact factor: 19.103
Authors: Fausto Salaffi; Marco Di Carlo; Marina Carotti; Paolo Fraticelli; Armando Gabrielli; Andrea Giovagnoni Journal: Radiol Med Date: 2018-04-23 Impact factor: 3.469
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