Researchers presented the case study of a patient with systemic sclerosis (SSc) and refractory gastroesophageal reflux disease (GERD) who was treated with an innovative endoscopic procedure known as antireflux mucosectomy in the journal Clinics and Research in Hepatology and Gastroenterology.
SSc is a multisystemic disease in which digestive disorders are common. Up to 9 in 10 patients experience gut abnormalities, including GERD and esophageal dysmotility. These 2 conditions can be mutually aggravating—studies indicate that esophageal dysmotility worsens GERD in about one-third of patients with SSc.
The standard treatment of GERD in patients with SSc is with proton pump inhibitors and dietary/lifestyle changes. Nevertheless, because GERD can be intolerable among some patients, physicians often need to increase the proton pump inhibitor dosage, which might still only offer partial relief. Antireflux mucosectomy is an innovative procedure that is intended to further alleviate GERD among patients with SSc; it involves a complete mucosal resection of three-quarters of the circumference of the esophageal junction, mimicking an antireflux valve.
The authors of the study discussed about a 52-year-old female with SSc whose disease manifestations included Raynaud’s disease and GERD. Investigations revealed that she suffered from significant GERD that was not relieved by medications. Her GERD symptoms were so severe that it caused her to lose 3 kg in weight and suffer from sleep disorders and a reduced quality of life.
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The patient consented to undergo an antireflux mucosectomy. This was the first time this procedure had been performed on a patient with SSc. One month postoperatively, the patient reported an 80% improvement in pyrosis. At 3 months, she complained of dysphagia and vomiting, but an endoscopic evaluation did not show any abnormalities. At 6 months, she described an overall satisfaction of 100% and a significantly improved quality of life.
“Future studies will be required, but it really seems that a new hope is emerging in these difficult cases,” the authors wrote.
Vitton V, Barthet M, Granel B, Gonzalez JM. Refractory GERD and systemic sclerosis: the end of a dead end? Clin Res Hepatol Gastroenterol. Published online May 13, 2023. doi:10.1016/j.clinre.2023.102140