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Abnormal esophageal acid exposure on high‐dose proton pump inhibitor therapy is common in systemic sclerosis patients
Author(s) -
Stern E. K.,
Carlson D. A.,
Falmagne S.,
Hoffmann A. D.,
Carns M.,
Pandolfino J. E.,
Hinchcliff M.,
Brenner D. M.
Publication year - 2018
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.13247
Subject(s) - medicine , hiatal hernia , high resolution manometry , reflux , gerd , gastroenterology , proton pump inhibitor , bolus (digestion) , cohort , retrospective cohort study , esophagus , disease
Background Esophageal dysfunction and gastro‐esophageal reflux disease ( GERD ) are common among patients with systemic sclerosis ( SS c). Although high‐dose proton pump inhibitors ( PPI s) typically normalize esophageal acid exposure, the effectiveness of PPI therapy has not been systematically studied in SS c patients. The aim of this study was to characterize reflux in SS c patients on high‐dose PPI using esophageal pH‐impedance testing. Methods In this case‐controlled retrospective analysis, 38 patients fulfilling 2013 American College of Rheumatology SS c criteria who underwent esophageal pH‐impedance testing on twice‐daily PPI between January 2014 and March 2017 at a tertiary referral center were compared with a control‐cohort of 38 non‐ SS c patients matched for PPI formulation and dose, hiatal hernia size, age, and gender. Patient clinical characteristics, including endoscopy and high‐resolution manometry findings, were assessed via chart review. Key Results On pH‐impedance, SS c patients had higher acid exposure times ( AET s) than controls. Sixty‐one percent of the SS c patients and 18% of the control patients had a total AET ≥4.5% ( P < .001). Systemic sclerosis patients also had significantly longer AET s, longer median bolus clearance, and lower nocturnal impedance values. Conclusions & Inferences Abnormal esophageal acid exposure despite high‐dose PPI therapy was common among patients with SS c. The lack of increased reflux episodes in the SS c patients, and longer bolus clearance times and lower nocturnal impedance, supports ineffective clearance as the potential mechanism. Systemic sclerosis patients may require adjunctive therapies to PPI s to control acid reflux.