Gastroesophageal reflux disease is associated with a more severe interstitial lung disease in systemic sclerosis in the EUSTAR cohort
Eliane Roth, Cosimo Bruni, L. Petelytska, Mike Oliver Becker, Rucsandra Dobrota, Suzana Jordan, Carina Mihai, Sinziana Muraru, Patricia E. Carreira, Jeska de Vries‐Bouwstra, Yolanda Braun‐Moscovici, Vasiliki Liakouli, Gianluca Moroncini, Christina Bergmann, Luc Mouthon, Christopher P. Denton, Maria De Santis, Alberto Cauli, Sabine Adler, Vera Bernardino, Marie‐Elise Truchetet, Madelon Vonk, Francesco Del Galdo, Anna‐Maria Hoffmann‐Vold, Oliver Distler, Muriel Elhaï, EUSTAR Collaborators, Serena Guiducci, Ulrich Walker, Florenzo Iannone, Radim Becvar, Otylia Kowal Bielecka, Maurizio Cutolo, Francesco Ciccia, Elise Siegert, Simona Rednic, Yannick Allanore, Panayiotis Vlachoyiannopoulos, Carlomaurizio Montecucco, Murat Inanc, Maria Martin, Beatriz Joven, Cioly Mendez, Srdan Novak, Gábor Kumánovics, Michele Iudici, Przemyslaw Kotyla, Elisabetta Zanatta, Katja Perdan-Pirkmajer, Bernard Coleiro, Silvia Svegliati, Devis Benfaremo, Chiara Paolini, Silvia Agarbati, Dominique Farge Bancel, Paolo Airò, Kristofer Andréasson, Mislav Radic, Alexandra Balbir-Gurman, Andrea Lo Monaco, Nicolas Hunzelmann, Annamaria Iagnocco, Luca Idolazzi, Josko Mitrovic, Voon Ong, Annalyn Nunag, Hanneke Knaapen, Sander van Leuven, Rogier Thurlings, Jelena Colic, Jörg Henes, Vera Ortiz-Santamaria, Johannes Pflugfelder, Dorota Krasowska, Samuel Rubeli, Michaela Köhm, Ivan Foeldvari, Gianluigi Bajocchi, José António Pereira da Silva, Bojana Stamenkovic, Antonio Tonutti, Francesca Motta, Claudia Ickinger, Nimmisha Govind, Lidia P Ananieva, Michael Hughes, Philipp Klemm, Ulf Müller-Ladner, Klaus Søndergaard, Merete Engelhart, Gabriella Szücs, Carlos de la Puente, Øyvind Midtvedt, Torhild Garen, Håvard Fretheim, Mona-Lovise Talaro Ramsli, David Launay, Valeria Riccieri, Andra Balanescu, Ami A Shah
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 = 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.