WESTPORT, CT (Reuters Health) – In patients with systemic sclerosis, severe esophageal manometric motor disturbances may lead to interstitial lung disease that rapidly progresses over time, French researchers report.
Dr. Isabelle Marie from the Universitaire de Rouen-Boisguillaume and colleagues studied 43 consecutive systemic sclerosis patients. Pulmonary function test results and high-resolution computerized tomography (HRCT) findings were compared in relation to the degree of esophageal motor dysfunction.
Patients with severe esophageal motor dysfunction (aperistalsis and decreased low esophageal pressure) had significantly decreased median values of diffusing capacity for carbon monoxide (DLco) (68%) compared with those with moderate esophageal motor dysfunction (93.57%) and those without esophageal motor dysfunction (103.70%, p = 0.048), the researchers report in the August issue of Arthritis Care and Research.
These patients also had a higher prevalence of interstitial lung disease (57.14%) compared with patients with moderate esophageal motor dysfunction (27.27%) or no esophageal motor dysfunction (18.18%, p = 0.037), Dr. Marie's group reports.
At 2 years' followup in 18 patients, those with severe esophageal motor dysfunction had a faster deterioration of median DLco (-16.04%) compared with patients without esophageal motor dysfunction (+1.47%, p = 0.022). They also had a higher frequency of interstitial lung disease (seven of 10 patients) compared with those without esophageal motor dysfunction (two of eight patients), the researchers found.
Dr. Marie and her team conclude that gastroesophageal reflux and repeated microaspiration of gastric contents may contribute to interstitial lung disease in systemic sclerosis. However, they say, it would take a large randomized trial to determine "whether therapy of gastroesophageal reflux in systemic sclerosis patients with severe esophageal motor involvement would improve or stop the course of interstitial lung disease or prevent interstitial lung disease onset."
Arthritis Care Res 2001;45:346-354.