Is gastroesophageal reflux contributing to lung scarring?
A research collaboration between the Royal Free and Royal Brompton hospitals, funded by Scleroderma and Raynaud's UK (SRUK), is investigating if reflux from the stomach into the oesophagus plays a role in lung scarring in scleroderma patients.
Close to 50% of scleroderma (SSc) patients are affected by lung scarring. This is the main cause of death in this condition, with an estimated mortality rate of 33%. Causes of this scarring are not yet known. Most SSc patients are reported to have problems with their oesophagus, the food pipe that leads into the stomach. In a healthy person, there is a small muscle at the base of the oesophagus that opens to allow food to pass into the stomach and closes to prevent the digestive juices in the stomach from flowing into the oesophagus. In some SSc patients, this muscle may become weak and no longer close properly. The contents of the stomach therefore enter the oesophagus and cause irritation of the pipe, sometimes causing heartburn and indigestion. In severe cases, the irritation can result in the narrowing of the oesophagus, thus causing swallowing difficulties. 'Gastroesophageal reflux' (GER) is the term given to the reflux of stomach contents into the oesophagus.
This study, led by Dr Elisabetta Renzoni at the Imperial College School of Medicine, is based on the theory that small amounts of stomach contents could travel up the oesophagus close to the throat and be inhaled into the lungs. This is 'microaspiration' and is a potential trigger of lung scarring. Oesophageal function will be examined in SSc patients who suffer from interstitial lung disease, such as the ability of food to be transported into the stomach, alongside questionnaires and tests to understand the frequency and severity of reflux episodes. Their saliva will also be assessed for markers of microaspiration, through monitoring pepsin levels. Pepsin is a protein that is normally only found in the stomach, therefore if it is present in the saliva, this provides evidence for the patient suffering from GER.
This study has the potential to make a significant impact, as establishing whether pepsin levels in saliva are a marker of microaspiration is of immediate clinical relevance as well as being informative to future research. Results from this investigation can therefore lead to huge benefits for the SRUK community.
If you are interested in helping SRUK to fund more work like this, then please visit our donations page here. We rely on the generosity of our community to continue to support groundbreaking research in both scleroderma and Raynaud's.
If you would like more information regarding how to manage gastrointestinal symptoms linked to scleroderma, please visit: Gastrointestinal complications from scleroderma
Information on another piece of new research can be found here: Mutant NOS1 New Diagnostic Marker Raynaud's Phenomenon