The following is a summary of “Gastrointestinal dysmotility is associated with proton pump inhibitor refractory esophagitis in patients with systemic sclerosis,” published in the September 2024 issue of Rheumatology by Alcala-Gonzalez et al.

Patients with systemic sclerosis often experience severe gastroesophageal reflux disease, even when treated with proton pump inhibitors (PPI). 

Researchers conducted a retrospective study to determine factors linked with PPI-refractory esophagitis.

They studied patients with systemic sclerosis who had an esophagogastroduodenoscopy while taking proton pump inhibitors (PPIs). Patients with PPI-refractory erosive esophagitis were compared to those with normal esophageal mucosa.

The results showed that 69 patients were included, of which 23 (33%) had PPI-refractory esophagitis (Grade A, 11; Grade B, 7; Grade C, 2; Grade D, 3) and 46 (67%) had normal esophageal mucosa. Patients with PPI-refractory esophagitis were more often diffuse SSc (43% vs. 17%, P= 0.041). Neither absent esophageal contractility (39% vs. 25%, P= 0.292) nor hypotensive lower esophageal sphincter (47% vs. 44%, P= 0.980) were associated with PPI-refractory esophagitis. Gastrointestinal dysmotility (abnormal gastric emptying and dilated small bowel loops) was related to PPI-refractory esophagitis (66% vs. 8%, P<0.001). In a multivariate analysis, gastrointestinal dysmotility (β=0.751, P=0.010) was independently associated with PPI-refractory esophagitis, while absent esophageal contractility (β=0.044, P=0.886) or hypotensive LES (β=-0.131, P=0.663) were not. 

They concluded gastrointestinal motor dysfunction, specifically in the stomach and small intestine, might be a significant factor in the development of PPI-refractory esophagitis in patients with systemic sclerosis.

Source: academic.oup.com/rheumatology/advance-article-abstract/doi/10.1093/rheumatology/keae481/7754086