Surgical management of gastroesophageal reflux disease in patients with systemic sclerosis

Yan, Jingliang; Strong, Andrew T.; Sharma, Govind; Gabbard, Scott; Thota, Priyaleela; Rodriguez, John; Kroh, Matthew

doi:10.1007/s00464-018-6115-2

Cited by 30 publications

(19 citation statements)

References 19 publications

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“…38 A recent study demonstrated that both gastric bypass and to a less extent fundoplication surgery led to an improvement or resolution in reflux symptoms in a small cohort of patients with SSc (n = 14). 39 Future studies are needed to assess long-term outcomes in patients undergoing these surgeries.…”

Section: New Approaches To Therapymentioning

confidence: 99%

Gastrointestinal involvement in systemic sclerosis: Effects on morbidity and mortality and new therapeutic approaches

Hoffmann‐Vold

Volkmann

2019

Journal of Scleroderma and Related Disorders

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The majority of research studies in systemic sclerosis focus largely on addressing skin and cardiopulmonary manifestations. Fewer studies assess the pathogenesis and treatment of gastrointestinal tract involvement in systemic sclerosis, despite the fact that the majority of patients with systemic sclerosis have gastrointestinal manifestations and these manifestations are a leading cause of death in systemic sclerosis. The present review provides a comprehensive update on morbidity and mortality outcomes related to gastrointestinal involvement in systemic sclerosis. This review also describes conventional and emerging approaches to managing gastrointestinal symptoms in systemic sclerosis. Recent developments in systemic sclerosis–gastrointestinal research efforts have revealed promising treatment targets, including specific auto-antibodies and microbiota alterations. This review will conclude with an overview of future research directions that may improve our understanding of systemic sclerosis–gastrointestinal involvement and ultimately help to alleviate suffering from this devastating dimension of systemic sclerosis.

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Section: New Approaches To Therapymentioning

confidence: 99%

Gastrointestinal involvement in systemic sclerosis: Effects on morbidity and mortality and new therapeutic approaches

Hoffmann‐Vold

Volkmann

2019

Journal of Scleroderma and Related Disorders

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“…Some expert centers utilize center-specific strategies to manage these patients in the pre-and posttransplant period and surgical measures may be effective in selected patients. [153][154][155][156] In addition to concerns around reflux, left ventricular involvement as a result of the same pathophysiologic processes that result in SSc manifestations elsewhere is possible. 157 Left ventricular diastolic dysfunction may increase the risk of primary graft dysfunction.…”

Section: Lung Transplantation In Ssc-ildmentioning

confidence: 99%

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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“…Similarly, Yan et al reported a complete reflux resolution in RYGB patients while 50% of patients in the fundoplication group reported unchanged symptoms. Furthermore, the authors suggested a potential benefit on pulmonary function, forced expiratory volumes in 1 s, and decreased immunosuppressant use after RYGB [ 17 ]. Because of the small number of patients, retrospective study design, different follow-up periods, and heterogeneous choice of fundoplication, it is not possible to determine whether RYGB is superior to fundoplication.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of recalcitrant gastroesophageal reflux disease in patients with systemic sclerosis: a systematic review

Aiolfi

Nosotti

Matsushima

et al. 2021

Langenbecks Arch Surg

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Introduction Gastroesophageal reflux disease (GERD) is frequently seen in patients with systemic sclerosis (SSc). Long-standing GERD may cause esophagitis, long-segment strictures, and Barrett’s esophagus and may worsen pre-existing pulmonary fibrosis with an increased risk of end-stage lung disease. Surgical treatment of recalcitrant GERD remains controversial. The purpose of this systematic review was to summarize the current data on surgical treatment of recalcitrant GERD in SSc patients. Materials and methods A systematic literature review according to PRISMA and MOOSE guidelines. PubMed, EMBASE, and Web of Science databases were consulted. Results A total of 101 patients were included from 7 studies. The age ranged from 34 to 61 years and the majority were females (73.5%). Commonly reported symptoms were heartburn (92%), regurgitation (77%), and dysphagia (74%). Concurrent pulmonary disease was diagnosed in 58% of patients. Overall, 63 patients (62.4%) underwent open fundoplication, 17 (16.8%) laparoscopic fundoplication, 15 (14.9%) Roux en-Y gastric bypass (RYGB), and 6 (5.9%) esophagectomy. The postoperative follow-up ranged from 12 to 65 months. Recurrent symptoms were described in up to 70% and 30% of patients undergoing fundoplication and RYGB, respectively. Various symptoms were reported postoperatively depending on the type of surgical procedures, anatomy of the valve, need for esophageal lengthening, and follow-up. Conclusions The treatment of recalcitrant GERD in SSc patients is challenging. Esophagectomy should be reserved to selected patients. Minimally invasive RYGB appears feasible and safe with promising preliminary short-term results. Current evidence is scarce while a definitive indication about the most appropriate surgical treatment is lacking.

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Surgical management of gastroesophageal reflux disease in patients with systemic sclerosis

Abstract: Laparoscopic RYGB as an anti-reflux procedure is safe and may provide an alternative to fundoplication in the treatment of GERD for systemic sclerosis patients with esophageal dysmotility.

Cited by 30 publications

References 19 publications

Gastrointestinal involvement in systemic sclerosis: Effects on morbidity and mortality and new therapeutic approaches

Gastrointestinal involvement in systemic sclerosis: Effects on morbidity and mortality and new therapeutic approaches

Systemic Sclerosis Associated Interstitial Lung Disease: A Comprehensive Overview

Surgical treatment of recalcitrant gastroesophageal reflux disease in patients with systemic sclerosis: a systematic review

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