Objectives: Gastroesophageal reflux disease (GERD) is frequent in systemic sclerosis (SSc) and could predict progression of interstitial lung disease (ILD). We aimed to analyse (1) the prevalence of GERD among SSc-ILD patients, (2) its association with disease characteristics and (3) predictive factors for ILD progression in SSc-ILD patients with GERD. Methods: SSc patients from the EUSTAR database with ILD were included. GERD was labelled as present if reflux/dysphagia was reported at the baseline visit or before. Disease characteristics of patients with and without GERD were compared at baseline. ILD progression was defined as relative FVC decline ≥10% or relative FVC decline between 5–9% in association with relative DLCO decline of ≥15% over 12 ± 3 months of follow-up. Prognostic factors for ILD progression, overall survival and progression-free survival in SSc-ILD patients with GERD were tested by multivariable Cox regression. Results: A total of 5462 SSc-ILD patients were included, 4400 (80.6%) had GERD. Patients with GERD presented more frequently with diffuse cutaneous SSc (OR: 1.44 [1.22–1.69], P < 0.001) and more severe lung involvement with lower FVC (85.8 ± 22.1 vs 90.2 ± 20.1, P < 0.001), lower DLCO (60.8 ± 19.7 vs 65.3 ± 20.6, P < 0.001) and worse performance at the 6-min walking test. Female sex (HR: 1.39 [1.07–1.80], P ¼ 0.012) and older age (HR: 1.02 [1.01–1.03], P < 0.001) independently predicted ILD progression in SSc-ILD patients with GERD. Conclusion: SSc-ILD patients with GERD appear to suffer from a more severe SSc disease. In this population, female sex may be considered a risk factor for ILD progression.
Gastroesophageal reflux disease is associated with a more severe interstitial lung disease in systemic sclerosis in the EUSTAR cohort / E. Roth, C. Bruni, L. Petelytska, M.O. Becker, R. Dobrota, S. Jordan, C. Mihai, S. Muraru, P.E. Carreira, J. De Vries-Bouwstra, Y. Braun-Moscovici, V. Liakouli, G. Moroncini, C. Bergmann, L. Mouthon, C.P. Denton, M. De Santis, A. Cauli, S. Adler, V. Bernardino, M. Truchetet, M. Vonk, F. Del Galdo, A. Hoffmann-Vold, O. Distler, M. Elhai, N. Null, S. Guiducci, U. Walker, F. Iannone, R. Becvar, O.K. Bielecka, M. Cutolo, F. Ciccia, E. Siegert, S. Rednic, Y. Allanore, P. Vlachoyiannopoulos, C. Montecucco, M. Inanc, M. Martin, B. Joven, C. Mendez, S. Novak, G. Kumánovics, M. Iudici, P. Kotyla, E. Zanatta, K. Perdan-Pirkmajer, B. Coleiro, S. Svegliati, D. Benfaremo, C. Paolini, S. Agarbati, D.F. Bancel, P. Airò, K. Andréasson, M. Radic, A. Balbir-Gurman, A.L. Monaco, N. Hunzelmann, A. Iagnocco, L. Idolazzi, J. Mitrovic, V. Ong, A. Nunag, H. Knaapen, S. Van Leuven, R. Thurlings, J. Colic, J. Henes, V. Ortiz-Santamaria, J. Pflugfelder, D. Krasowska, S. Rubeli, M. Köhm, I. Foeldvari, G. Bajocchi, J.A.P. Da Silva, B. Stamenkovic, A. Tonutti, F. Motta, C. Ickinger, N. Govind, L.P. Ananieva, M. Hughes, P. Klemm, U. Müller-Ladner, K. Søndergaard, M. Engelhart, G. Szücs, C. De La Puente, Ø. Midtvedt, T. Garen, H. Fretheim, M.T. Ramsli, D. Launay, V. Riccieri, A. Balanescu, A.A. Shah, A.M. Gheorghiu, A. Wirsching, J. Auth, A. Ramming, H. Kartalcik, F. Ingegnoli, B. Dunogue, B. Chaigne, V. Smith, F.P. Cantatore, M. Mogensen, C.A. Von Mühlen, F. Lauffer, P. Wiland, M. Vanthuyne, J.J. Alegre-Sancho, M. Aringer, E. De Langhe, B. Ani, S. Yavuz, B. Granel, C. De Souza Müller, S. Agachi, M. Pileckyte, S. Stebbings, A. Vacca, P.D. Sampaio-Barros, K. Solanki, D. Veale, E. Loyo, W.A.A.A. Mohamed, J. Olas, E. Rosato, F.Y. Zhini, C. Tanaseanu, R. Foti, C. Ancuta, B. Maurer, M. Olesinska, C. Kayser, N. Fathi, J.J.G. Martín, S. Blaise, P. Senet, E. Chatelus, I. Litinsky, M. Koenig, S. Hoa, J. Senécal, R. Cheema, B.A. Pitarch, L. Green, V. Kakkar, S. Di Donato, G. Seskute, L.A. Saketkoo, E. Kerzberg, B.V. Bianchi, I. Castellví, J. Milas-Ahic, R. Visevic, M. Limonta, D. Rimar, M. Couto, C. Ribi, A. Marcoccia, S. Kahl, V.M. Hsu, T. Martin, S. Moiseev, L.S. Chung, T. Schmeiser, D. Majewski, A. Wojteczek, J. Martínez-Barrio, D. Khanna, A.C. Rodrigues, G. Riemekasten, L. Santos, Y. Levy, E. Rezus, D.B. De Araujo, R. Talotta, S. Bongiovanni, M. Brzosko, H. Poormoghim, M. Mamani, I. Kötter, G. Cuomo, O.M. Epis, P. Sfikakis, J. Markus, D. Furst, A. Ramazan, H.U. Scherer, T.W.J. Huizinga, E. Lazaro, A. Lescoat, M. Matucci-Cerinic, J. Spierings, L. Rudnicka, S. Oliveira, F. Atzeni, M. Kuwana, A. Mekinian, M. Martin, Y. Tanaka, H. Yasuoka, C.S. Aznar, T. Atsumi, M. Pârvu, G. Boleto, N. Del Papa, K. Kastrati, J.B. Shimol, A. Bazela-Ostromecka, E. Selvi, Y. Kawaguchi, T. Soukup, A.N. Conde, M. Geroldinger-Simic, I. Rodríguez-Pintó, K. Voigt, T. Kubacki, O. Garmish, M. Mosca, U. Gerth, M. Dzhus, T. Ishii, D.T. Karadag, A. Batalov, K. Ginosyan, V. Mukuchyan, V. Vardanyan, A. Haroyan, T. Sokka-Isler, L. Harty, M. Geneva-Popova, M. Naffaa, C. Maglio, C.I.S. Santos, O. Masato, F. Iwata, M. Hinchcliff, S. Tharwat, A. Cordeiro, R. Giacomelli, F. Benvenuti. - In: RHEUMATOLOGY. - ISSN 1462-0324. - 64:SI(2025 Dec 01), pp. 63-72. [10.1093/rheumatology/keaf016]
Gastroesophageal reflux disease is associated with a more severe interstitial lung disease in systemic sclerosis in the EUSTAR cohort
F. Ingegnoli;
2025
Abstract
Objectives: Gastroesophageal reflux disease (GERD) is frequent in systemic sclerosis (SSc) and could predict progression of interstitial lung disease (ILD). We aimed to analyse (1) the prevalence of GERD among SSc-ILD patients, (2) its association with disease characteristics and (3) predictive factors for ILD progression in SSc-ILD patients with GERD. Methods: SSc patients from the EUSTAR database with ILD were included. GERD was labelled as present if reflux/dysphagia was reported at the baseline visit or before. Disease characteristics of patients with and without GERD were compared at baseline. ILD progression was defined as relative FVC decline ≥10% or relative FVC decline between 5–9% in association with relative DLCO decline of ≥15% over 12 ± 3 months of follow-up. Prognostic factors for ILD progression, overall survival and progression-free survival in SSc-ILD patients with GERD were tested by multivariable Cox regression. Results: A total of 5462 SSc-ILD patients were included, 4400 (80.6%) had GERD. Patients with GERD presented more frequently with diffuse cutaneous SSc (OR: 1.44 [1.22–1.69], P < 0.001) and more severe lung involvement with lower FVC (85.8 ± 22.1 vs 90.2 ± 20.1, P < 0.001), lower DLCO (60.8 ± 19.7 vs 65.3 ± 20.6, P < 0.001) and worse performance at the 6-min walking test. Female sex (HR: 1.39 [1.07–1.80], P ¼ 0.012) and older age (HR: 1.02 [1.01–1.03], P < 0.001) independently predicted ILD progression in SSc-ILD patients with GERD. Conclusion: SSc-ILD patients with GERD appear to suffer from a more severe SSc disease. In this population, female sex may be considered a risk factor for ILD progression.
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