Background A reduced basal lower esophageal sphincter (LES) pressure (LES<15 mmHg) is recognized as an early finding of esophageal involvement in systemic sclerosis (SSc) patients (1).

Objectives We aimed to investigate potential associations of a reduced basal LES pressure at first observation with the development of new gastrointestinal symptoms and with self-administered questionnaires devoted to assess the impact of gastrointestinal involvement on quality of life during follow-up (FU) in SSc patients.

Methods SSc patients meeting the 2013 ACR/EULAR criteria for disease classification with measurement of basal LES pressure at the first observation and at least one FU visit with complete clinical evaluation were enrolled. The gastroesophageal reflux disease questionnaire (GerdQ) (2, 3) was administered to explore the impact of esophageal symptoms on patient's disease perception and to estimate the risk for GERD. Associations between reduced basal LES pressure and new onset gastrointestinal symptoms at FU were analyzed by Fisher's exact test, while the GerdQ score in SSc patients with or without a reduced basal LES pressure was analyzed by Mann-Whitney U test.

Results Fifty-nine SSc patients, aged 47±13 years, were investigated (75% females; median disease duration 7 years, range 0.5–43). Eighty % of patients had a limited SSc subset (lcSSc); 20% had a diffuse subset (dcSSc). All patients were ANA positive (36% had anti-centromere antibodies, 39% anti-Scl70+; 5% anti-RNApolymerase III; 1.7% anti-PmScl; 1.7% anti-U1RNP). All patients were under proton pomp inhibitors ± prokinetics during FU. Forty-two % of patients had already esophageal symptoms at baseline; 32% developed new esophageal symptoms and 40% new gastric and/or intestinal symptoms during observation (median FU 4 years; range 0.5–15.5). Baseline basal LES pressure was reduced in 63% of patients. Out of these, 49% had also esophageal symptoms. Median GerdQ score at the end of FU was significantly higher in patients with baseline reduced LES pressure (7, range 3–14 versus 6, range 2–11; p<0.001). However, even though patients with baseline reduced LES pressure had a higher prevalence of a GerdQ score higher than 7, indicating an impact of esophageal symptoms on their quality of life (12/37 versus 4/22), this difference was not statistically significant.

Conclusions Our data suggest that evaluation at baseline of esophageal involvement in SSc patients by esophageal manometry can predict the development of more severe symptoms over time, as evaluated by the association with a higher score at GerdQ also in initially asymptomatic patients. Larger studies need to be carried out to confirm this association.

1. Sjögren RW. Arthritis Rheum 1994; 37: 1265–82

2. Jonasson C et al. Aliment Pharmacol Ther 2013; 37: 564–72

3. Chunlertrith K et al. Clin Exp Rheumatol 2014; 32 (6 Suppl 86): S98–102

Disclosure of Interest None declared