THE REAL PREVALENCE OF EROSIVE ESOPHAGITIS AND BARRETT'S ESOPHAGUS IN SYSTEMIC SCLERODERMA: DATA FROM 12-MONTHS PROSPECTIVE STUDY

Abstract

Complicated forms of reflux-esophagitis, i.e., erosive esophagitis and Barrett's esophagus (BE) — are common types of visceral pathology in systemic scleroderma (SSD), which require adequate therapy and follow up. Although real prevalence of esophageal involvement in SSD in Russian patients remains uncertain. Objective — to identify prevalence of erosive esophagitis and BE, and to quantify gastro-intestinal (GI) symptoms in patients with SSD. Material and methods. During 1 year (December 2009 — January 2011) all consecutive SSD patients, hospitalized to FSBI «SRIR» RAMS, after signing informed consent, were subjected to esophagogastroduodenoscopy with biopsy of esophageal mucosa in upper 1/3. Totally 123 patients were examined (96,8% females, 3,2% males, aged 50,5±13,1 years). Esophageal mucous was evaluated for presence of pathologic changes and BE (intestinal metaplasia in biopsy samples was a BE diagnostic criterion). SODA questionnaire was used to quantify GIT symptoms Results. Erosive esophagitis was detected in 30 (24,3%) patients, BE — in 11 (8,9%). In 80% of patients marked changes in esophageal mucosa were associated with typical symptoms (heartburn, regurgitaion, dysphagia), while in some cases (in 3 patients) erosive esophagitis and BE were asymptomatic. Quantitative evaluation of symptoms with SODA questionnaire demonstrated clear correlation between subjective assessment and severity of esophageal pathologic changes. In patients with erosive gastritis and BE the SODA «pain» and «non-pain» parameters scores were significantly higher and satisfaction in dyspepsia management was lower (p<0,05), then in individuals without erosions and mucosal inflammation. Here was no clear correlation between esophageal pathology and SSD type (limited, diffuse), age, duration of the disease, presence of pulmonary interstitial lesion and Sjogren's syndrome. Patients with erosive esophagitis were significantly more often (36,6%) using proton pomp inhibitors as compared to individuals without apparent esophageal pathology (22,0%; p<0,001). Conclusion. Erosive esophagitis is diagnosed in each 4th patient with SSD.EB is also quite common in this pathology, predetermining the necessity of regular endoscopic check-ups in all SSD patients. SODA questionnaire is a useful tool to evaluate the severity of upper GIT symptoms in SSD patients during follow up.

Keywords

• systemic scleroderma
• esophagitis
• barrett's esophagus
• proton pomp inhibitors
• soda questionnaire