Gastroesophageal reflux disease (GERD) is very common in systemic scleroderma. GERD is characterized by the backup of stomach acid into the esophagus when the muscles of the lower esophageal sphincter, between the esophagus and stomach, are too weak to close correctly. Reflux acid touches the lining of the esophagus as a result, and a burning sensation is felt — usually called heartburn or acid indigestion.
This problem, of course, is also common to many adults. But in scleroderma patients it can develop into a chronic condition, GERD, that can be serious if left untreated. People with systemic scleroderma may exhibit a range of gastrointestinal problems, from heartburn and regurgitation to difficulties swallowing (dysphagia) and tooth decay. Long-term complications can include esophageal ulceration and Barrett’s esophagus, a risk factor for esophageal cancer.
Not all scleroderma patients experience GERD symptoms, however, and screening for the disease even in asymptomatic patients is advised.
Non-pharmacological treatment involves lifestyle changes, and can include avoiding food triggers, such as acidic foods, fatty or fried foods, tomato sauce, chocolate, and garlic; eating smaller and more frequent meals; reducing alcohol and caffeine intake; quitting smoking; and not lying down for at least three hours after eating a meal.
Pharmacological treatments include such over-the-counter medications as H2 blockers (cimetidine, ranitidine, and famotidine), which reduce acid production; proton-pump inhibitors (omeprazole and lansoprazole [available both as non-prescription or prescription], or the prescription-only pantoprazole, dexlansoprazole, and rabeprazole), which effectively work to block acid production, allowing time for esophageal tissue to heal; and prokinetics (like urecholine or metoclopramide), which help to strengthen the sphincter and assist in emptying the stomach. Prokinetics, however, are known to carry side effects.
GERD study in scleroderma patients
A gastroesophageal reflux Phase 3 study (NCT01878526), evaluating the proton-pump inhibitor omeprazole in scleroderma patients with omeprazole-resistant GERD (GERD-SSc) is underway, and currently recruiting participants.
The study’s three top goals are:
- Determine the prevalence of omeprazole-resistant GERD in scleroderma patients.
- Compare the effectiveness of omeprazole in combination with algycon (an organic salt used as an antacid), and in combination with domperidone (an anti-sickness drug), on the severity of reflux symptoms in these patients.
- Compare the effectiveness of omeprazole plus algycon, and omeprazole plus domperidone, on the frequency of symptoms.
Study outcomes are expected in late 2019 or early 2020.
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