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. 2025 Dec 1;64(SI):SI63-SI72.
doi: 10.1093/rheumatology/keaf016.

Gastroesophageal reflux disease is associated with a more severe interstitial lung disease in systemic sclerosis in the EUSTAR cohort

Eliane Roth  1 , Cosimo Bruni  1 , Liubov Petelytska  1 , Mike Oliver Becker  1 , Rucsandra Dobrota  1 , Suzana Jordan  1 , Carina Mihai  1 , Sinziana Muraru  1 , Patricia E Carreira  2 , Jeska De Vries-Bouwstra  3 , Yolanda Braun-Moscovici  4 , Vasiliki Liakouli  5 , Gianluca Moroncini  6 , Christina Bergmann  7 , Luc Mouthon  8 , Christopher P Denton  9 , Maria De Santis  10   11 , Alberto Cauli  12 , Sabine Adler  13 , Vera Bernardino  14 , Marie-Elise Truchetet  15 , Madelon Vonk  16 , Francesco Del Galdo  17 , Anna-Maria Hoffmann-Vold  1   18 , Oliver Distler  1 , Muriel Elhai  1 ; EUSTAR Collaborators
Collaborators, Affiliations

Gastroesophageal reflux disease is associated with a more severe interstitial lung disease in systemic sclerosis in the EUSTAR cohort

Eliane Roth et al. Rheumatology (Oxford). .

Abstract

Objectives: Gastroesophageal reflux disease (GERD) is frequent in systemic sclerosis (SSc) and could predict progression of interstitial lung disease (ILD). We aimed to analyse (1) the prevalence of GERD among SSc-ILD patients, (2) its association with disease characteristics and (3) predictive factors for ILD progression in SSc-ILD patients with GERD.

Methods: SSc patients from the EUSTAR database with ILD were included. GERD was labelled as present if reflux/dysphagia was reported at the baseline visit or before. Disease characteristics of patients with and without GERD were compared at baseline. ILD progression was defined as relative FVC decline ≥10% or relative FVC decline between 5-9% in association with relative DLCO decline of ≥15% over 12 ± 3 months of follow-up. Prognostic factors for ILD progression, overall survival and progression-free survival in SSc-ILD patients with GERD were tested by multivariable Cox regression.

Results: A total of 5462 SSc-ILD patients were included, 4400 (80.6%) had GERD. Patients with GERD presented more frequently with diffuse cutaneous SSc (OR: 1.44 [1.22-1.69], P < 0.001) and more severe lung involvement with lower FVC (85.8 ± 22.1 vs 90.2 ± 20.1, P < 0.001), lower DLCO (60.8 ± 19.7 vs 65.3 ± 20.6, P < 0.001) and worse performance at the 6-min walking test. Female sex (HR: 1.39 [1.07-1.80], P = 0.012) and older age (HR: 1.02 [1.01-1.03], P < 0.001) independently predicted ILD progression in SSc-ILD patients with GERD.

Conclusion: SSc-ILD patients with GERD appear to suffer from a more severe SSc disease. In this population, female sex may be considered a risk factor for ILD progression.

Keywords: gastroesophageal reflux disease; interstitial lung disease; progression; systemic sclerosis.

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Figures

Figure 1.
Figure 1.
Flow-chart of study process. Progression of ILD if [1] FVC decline ≥ 10% or [2] FVC decline 5–9% in association with DLCO decline ≥15% in 12±3 months [26]. ACR/EULAR: American College of Rheumatology/European League against rheumatism; GERD: gastroesophageal reflux disease; HRCT: high-resolution computed tomography; ILD: interstitial lung disease; PFT: pulmonary function tests; PPI: proton pump inhibitors; RHC: right heart catheter; SSc: systemic sclerosis
See this image and copyright information in PMC

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