Oesophageal diameter is associated with severity but not progression of systemic sclerosis‐associated interstitial lung disease

Winstone, Tiffany A.; Hague, Cameron; Soon, Jeanette; Sulaiman, Nada; Murphy, Darra; Leipsic, Jonathon; Dunne, James V.; Wilcox, Pearce; Ryerson, Christopher J.

doi:10.1111/resp.13309

Cited by 20 publications

(10 citation statements)

References 29 publications

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“…[92][93][94][95][96] In a recently published study of 145 patients with SSc, esophageal dilatation and hiatus hernia were associated with greater degrees of fibrosis on CT and lower baseline FVC, but not disease progression, after correction for these baseline measures. 97 These results confirm those of others which demonstrate that esophageal dilatation is associated with more severe ILD at baseline. 98 Functional measures of esophageal involvement did not predict lung function decline in a recent cohort.…”

Section: The Role Of Reflux In Ssc-ildsupporting

confidence: 91%

Systemic Sclerosis Associated Interstitial Lung Disease: A Comprehensive Overview

Mackintosh

Stainer

Barnett

et al. 2019

Semin Respir Crit Care Med

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Interstitial lung disease (ILD) is a common complication of systemic sclerosis (SSc). SSc-ILD adversely impacts quality of life and is currently the leading cause of death in this multisystem disease. Identifying clinically significant SSc-ILD is critically important. Accurate staging and prognostication remain difficult; however, significant advances have been made in the last decade. Evidence supports the need to treat patients with extensive and/or progressive SSc-ILD, while only a subset of patients with limited ILD may require treatment. Research is urgently required to allow improved prediction of patients at risk of ILD progression at an early point in the disease, and ideally prior to its onset, to allow prevention. The last decade has seen the publication of landmark clinical trials for SSc-ILD. More effective strategies with less toxicity are under investigation. For those with refractory or very advanced disease, studies into disease-specific palliative approaches are in their infancy. Lung transplantation as an option for SSc-ILD remains patient- and center-specific, with data to suggest equivalent outcomes to other fibrotic lung diseases, in carefully selected cases. This review aims to provide a comprehensive overview of all key aspects of SSc-ILD.

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Section: The Role Of Reflux In Ssc-ildsupporting

confidence: 91%

Systemic Sclerosis Associated Interstitial Lung Disease: A Comprehensive Overview

Mackintosh

Stainer

Barnett

et al. 2019

Semin Respir Crit Care Med

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“…In our study, patients with extensive ILD displayed greater tracheal area than patients without pulmonary involvement and patients with limited ILD; all of these patients, in turn, displayed greater tracheal area than the control subjects. Several recent studies have shown that larger esophageal diameter is associated with higher pulmonary fibrosis and worse lung function in individuals with scleroderma [ 35 , 36 ]. Since microaspiration secondary to gastro-esophageal reflux is associated with the progression of pulmonary fibrosis in scleroderma [ 37 , 38 ], we think that the tracheal pathology may also contribute to this phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Computed tomography trachea volumetry in patients with scleroderma: Association with clinical and functional findings

et al. 2018

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BackgroundIn scleroderma, excessive collagen production can alter tracheal geometry, and computed tomography (CT) volumetry of this structure may aid in detecting possible abnormalities. The objectives of this study were to quantify the morphological abnormalities in the tracheas of patients with scleroderma and to correlate these findings with data on clinical and pulmonary function.MethodsThis was a cross-sectional study in which 28 adults with scleroderma and 27 controls matched by age, gender and body mass index underwent chest CT with posterior segmentation and skeletonization of the images. In addition, all participants underwent pulmonary function tests and clinical evaluation, including the modified Rodnan skin score (mRSS).ResultsMost patients (71.4%) had interstitial lung disease on CT. Compared to controls, patients with scleroderma showed higher values in the parameters measured by CT trachea volumetry, including area, eccentricity, major diameter, minor diameter, and tortuosity. The tracheal area and equivalent diameter were negatively correlated with the ratio between forced expiratory flow and forced inspiratory flow at 50% of forced vital capacity (FEF50%/FIF50%) (r = -0.44, p = 0.03 and r = -0.46, p = 0.02, respectively). The tracheal tortuosity was negatively correlated with peak expiratory flow (r = -0.51, p = 0.008). The mRSS showed a positive correlation with eccentricity (r = 0.62, p < 0.001) and tracheal tortuosity (r = 0.51, p = 0.007), while the presence of anti-topoisomerase I antibody (ATA) showed a positive correlation with tracheal tortuosity (r = 0.45, p = 0.03).ConclusionsIn a sample composed predominantly of scleroderma patients with associated interstitial lung disease, there were abnormalities in tracheal geometry, including greater eccentricity, diameter and tortuosity. In these patients, abnormalities in the geometry of the trachea were associated with functional markers of obstruction. In addition, tracheal tortuosity was correlated with cutaneous involvement and the presence of ATA.

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“…In a recent publication in Respirology , Winstone et al . retrospectively studied the association of hiatal hernia and oesophageal diameter on high‐resolution computed tomography (HRCT) with ILD severity as assessed by HRCT lung fibrosis score, rate of ILD progression measured by decline in lung function and increase in fibrosis on HRCT and mortality in a cohort of 145 patients with systemic sclerosis . The authors found that oesophageal diameter is more than twice as large (mean diameter of 2.3 cm) as in a previous study of normal controls (maximal diameter of 1 mm).…”

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confidence: 83%

“…Recent studies suggesting that proton pump inhibitor therapy is associated with numerous adverse effects, including increased risk of pneumonia, may prompt reconsideration of their inclusion in routine reflux management . The work of Winstone et al . compels us to conduct rigorous clinical trials to determine the role of microaspiration in the development and progression of ILD.…”

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confidence: 99%

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Systemic sclerosis‐associated interstitial lung disease: Role of the oesophagus in outcomes

Strek

2018

Respirology

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Oesophageal diameter is associated with severity but not progression of systemic sclerosis‐associated interstitial lung disease

Abstract: Oesophageal diameter and hiatal hernia are independently associated with SSc-ILD severity and mortality, but not with ILD progression or asymmetric disease. Oesophageal disease is unlikely to be a significant driver of ILD progression in SSc.

Cited by 20 publications

References 29 publications

Systemic Sclerosis Associated Interstitial Lung Disease: A Comprehensive Overview

Systemic Sclerosis Associated Interstitial Lung Disease: A Comprehensive Overview

Computed tomography trachea volumetry in patients with scleroderma: Association with clinical and functional findings

Systemic sclerosis‐associated interstitial lung disease: Role of the oesophagus in outcomes

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