Proton pump inhibitors in systemic sclerosis: a reappraisal to optimise treatment of gastro-oesophageal reflux disease

Hughes, Michael; Allanore, Yannick; Baron, Murray; Galdo, Francesco Del; Denton, Christopher P.; Frech, Tracy; Fürst, Daniel E.; Galetti, Ilaria; Dagna, Lorenzo; Herrick, Ariane L.; Kuwana, Masataka; Matucci-Cerinic, Pietro; Murray, Charles; Proudman, Susanna; Matucci‐Cerinic, Marco

doi:10.1016/s2665-9913(22)00183-7

Cited by 8 publications

(6 citation statements)

References 75 publications

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“…Increasing awareness of the potential adverse effects of PPIs has led to some uncertainty about their use in SSc [ 8 ]. A recent review article discussed the difficulties in balancing the benefit of PPI use in SSc with potential adverse effects.…”

Section: Discussionmentioning

confidence: 99%

“…A recent review article discussed the difficulties in balancing the benefit of PPI use in SSc with potential adverse effects. The most common side effects reported with PPI use are osteoporosis, hypomagnesemia and atrophic gastritis [ 8 ]. While the use of PPIs has been associated with development of SIBO in SSc, due to decreased acidity of gastric contents, we did not find PPI use to be associated with development of SIBO in our cohort [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, in animal models, chronic aspiration resulted in parenchymal fibrosis [ 6 , 7 ]. In SSc, the risk of aspiration of gastric contents is high due to the combination of oesophageal dysmotility, hypotensive lower oesophageal sphincter (LES) and delayed gastric motility [ 5 , 8 ]. As such, it is not surprising that previous studies have demonstrated a relationship between the severity of GORD measured on pH-metry and manometry and the presence and severity of ILD measured by high resolution computed tomography (HRCT) of the chest and spirometry [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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The impact of gastroesophageal reflux disease and its treatment on interstitial lung disease outcomes

Quinlivan,

Neuen,

Hansen

et al. 2024

Arthritis Res Ther

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Background To determine the relationship between gastroesophageal reflux disease (GORD) and its treatment and interstitial lung disease in patients with systemic sclerosis (SSc). Methods SSc patients from the Australian Scleroderma Cohort Study (ASCS) were included. GORD was defined as self-reported GORD symptoms, therapy with a proton pump inhibitor (PPI) or histamine 2 receptor antagonist (H2RA) and/or the presence of reflux oesophagitis diagnosed endoscopically. The impact of GORD and its treatment on ILD features (including severity and time to ILD development) and survival was evaluated. Results GORD was a common manifestation affecting 1539/1632 (94%) of SSc patients. GORD affected 450/469 (96%) of those with SSc-ILD cohort. In SSc-ILD, there was no relationship between the presence of GORD or its treatment and time to ILD development or ILD severity. However, GORD treatment was associated with improved survival in those with ILD (p = 0.002). Combination therapy with both a PPI and a H2RA was associated with a greater survival benefit than single agent therapy with PPI alone (HR 0.3 vs 0.5 p < 0.050 respectively). Conclusion GORD is a common SSc disease manifestation. While the presence or treatment of GORD does not influence the development or severity of ILD, aggressive GORD treatment, in particular with a combination of PPI and H2RA, is associated with improved survival in those with SSc-ILD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The impact of gastroesophageal reflux disease and its treatment on interstitial lung disease outcomes

Quinlivan,

Neuen,

Hansen

et al. 2024

Arthritis Res Ther

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“…12,13 Moreover, GERD and chronic microaspiration have been associated with interstitial lung disease (ILD) in SSc. [14][15][16] In SSc, proton pump inhibitors (PPIs) represent one of the major achievements in the management of GI involvement, and are widely prescribed to successfully treat GERD in the general population, being often available "over the counter" without prescription. However, commonly standard doses of PPIs often achieve only a partial effect and/or are sometimes ineffective in patients with SSc.…”

Section: Introductionmentioning

confidence: 99%

“…Long‐term uncontrolled GERD can also result in chronic inflammation of the GI tract, with potentially serious complications, 11 including stricture formation and malignant change 12,13 . Moreover, GERD and chronic microaspiration have been associated with interstitial lung disease (ILD) in SSc 14–16 Proton pump inhibitors (PPIs) are frequently used in patients with systemic sclerosis; however, there is significant heterogeneity in practice. Although PPIs are effective in the majority of patients who receive them, patients have significant concerns regarding long‐term safety. Patient education about receiving PPIs is often neglected, and a surgical approach is not widely discussed. …”

Section: Introductionmentioning

confidence: 99%

A Multinational Survey Investigating the Unmet Needs and Patient Perspectives Concerning Proton Pump Inhibitors in Systemic Sclerosis

Bandini,

Alunno,

Pinheiro

et al. 2024

Arthritis Care & Research

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ObjectiveProton Pump Inhibitors (PPIs) are widely used to treat gastroesophageal reflux disease (GERD) in Systemic Sclerosis (SSc). However, not all patients adequately respond to the treatment, and there are frequent concerns about the safety of long‐term use of PPIs. Our aim was to identify the main problems/complaints of SSc patients on PPIs, as well as understand their unmet needs.MethodsSSc patients treated with PPIs were invited through international patient associations and social media to participate in an online survey.ResultsWe gathered 301 valid responses from 14 countries (UK 19.3% and US 70.4%). Multiple PPIs use (two: 30% and three: 21% in series) was common. The majority (89%) reported improvement in GI symptoms from PPIs. Side effects attributed to PPIs were uncommon (19%); however, most (79%) were potentially concerned. Around half (58%) had received lifestyle information and most (85%) had searched online for information about PPIs. Only in the minority (12%), had a surgical approach been discussed; however, half (46%) indicated that they would be willing to undergo surgery to resolve their GERD symptoms, but had important concerns.ConclusionDespite the frequent use of PPIs in SSc, there is significant heterogeneity in use, and combination therapy (PPIs plus other medication for acid reflux) is not uncommon (~40%). Patients have significant concerns about PPIs side effects. Education about PPIs is often neglected, and patients very frequently use online sources to obtain information on drug treatment. A surgical approach is infrequently discussed, and patients fear this potential therapeutic approach.This article is protected by copyright. All rights reserved.

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Managing Symptoms of Systemic Sclerosis for the Allergist-Immunologist

Elahee,

Domsic

2024

Curr Allergy Asthma Rep

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Proton pump inhibitors in systemic sclerosis: a reappraisal to optimise treatment of gastro-oesophageal reflux disease

Cited by 8 publications

References 75 publications

The impact of gastroesophageal reflux disease and its treatment on interstitial lung disease outcomes

The impact of gastroesophageal reflux disease and its treatment on interstitial lung disease outcomes

A Multinational Survey Investigating the Unmet Needs and Patient Perspectives Concerning Proton Pump Inhibitors in Systemic Sclerosis

Managing Symptoms of Systemic Sclerosis for the Allergist-Immunologist

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