Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Esophageal Involvement in Systemic Sclerosis and Rheumatoid Arthritis: Prevalence of Esophagitis and Barrett's Esophagus.
Karateev, Andrey E., Movsisyan, Mikael M., Ananieva, Lidiya P., Radenska-Lopovok, Stefka G.
Esophageal involvement is a typical visceral manifestation of systemic sclerosis (SSc). Life threatening complications of esophagitis in scleroderma such as ulcers and Barrett's esophagus (BE) must be actively monitored and require long-term treatment.
To assess prevalence of esophageal involvement in SSc and rheumatoid arthritis (RA) patients, to reveal connection between clinical manifestation and endoscopic findings in patients with scleroderma esophagitis. Also, to assess effectiveness of proton pump inhibitors (PPIs).
356 patients with SSc (females 92,6%; males 7,4%, age 47,8 + 19,7 years) and 1018 patients with RA (females 89,0%, males 11,0%, age 44.1 + 16.3 years), among whom glucocorticoids (GC) were administered in 66,7% vs 52,6% of patients, respectively. 1,6% vs 82,9% of patients were treated with NSAIDs, 13,2% vs 0% - D-penicillamine, 15,7% vs 56,5% - cytotoxics, 23,7% vs 8,7% - PPIs. All patients underwent upper gastrointestinal endoscopy.
Subjective symptoms of esophageal pathology were detected in 64,0% vs 33,9% of patients with SSc and RA (p<0.001). Dysphagia and substernal ache were revealed in 10,1% and 7,0% of SSc patients, and only in 1,7% of patients with RA. Accoding to endoscopy results musocal hyperemia was seen in 27,4% vs 1,5% of patients, erosive esophagitis in 21,9% vs 2,2%, ulcers of the esophagus in 4 (1,1%) vs 0 (p=0,000) patients. Esophageal mucosal biopsy was performed in 92 patients with SSc and we revealed BE (intestinal metaplasia) in 19 patients (20,1%). No cases of BE were detected in RA patients. There was reliable link between symptoms and development of erosive esophagitis (p=0,001). At the same time we didn't find correlation between esophagus involvement, age, disease type (limited or systemic) and drugs administration (NSAIDs, GC, cytotoxics). Against the background of regular administration of PPIs (90 SSc patients) erosive esophagitis was detected in 35,0%, BE in 36,8% of patients. All 4 patients with esophageal ulcers were treated with PPIs.
According to our study esophageal involvement was revealed in majority of SSc and only few in RA patients. BE a frequent complication of esophagitis in scleroderma patients, which requires regular endoscopy investigation in all patients with SSc. Erosive esophagitis is often accompanied by clear clinical presentation, however some cases remain asymptomatic. PPIs are not always effective enough, which defines the necessity of administration of these drugs in higher doses or combined treatment regimen usage.
To cite this abstract, please use the following information:
Karateev, Andrey E., Movsisyan, Mikael M., Ananieva, Lidiya P., Radenska-Lopovok, Stefka G.; Esophageal Involvement in Systemic Sclerosis and Rheumatoid Arthritis: Prevalence of Esophagitis and Barrett's Esophagus. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :684