Individualized Management of Severe Gastroesophageal Reflux Disease Secondary to Scleroderma: Case Study and Literature Review_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 HUZhi-wei ¹ , WUJi-min ¹ ,  WANGZhong-gao ¹ , ZHANGYu ¹ , JITao ¹ , YANChao ² , DUXing ²

1. Department of Gastroesophageal Reflux Disease, Rocket Force General Hospital, PLA, Beijing 100088, China;
2. Vascural Surgery Department, Xuanwu Hospital, Capital Medical University, Beijing 100053, China;

Corresponding author：

WANGZhong-gao, Email: zhonggaowang@126.com

Keywords：

Scleroderma; Esophageal motility; Gastroesophageal reflux disease; Esophagitis; Laparoscopic fundoplication

DOI：

10.7507/1007-9424.20160312

Video：

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Objective To investigate the individualized management of severe gastroesophageal reflux disease (GERD) secondary to scleroderma, particularly the safety and feasibility of laparoscopic Toupet fundoplication for this entity. Methods From June, 2011 to June, 2014 six inpatient cases had severe GERD secondary to scleroderma were documented. Endoscopy, esophageal high-resolution manometry and 24 hours reflux monitoring were applied for GERD evaluation. Maintenance of conservative treatment was carried out for the 2 cases who responsed well to medication therapy, laparoscopic Toupet fundoplication was done for the 4 cases who had extraesophageal symptom and not well controlled by medication. The patients were followed-up for an average of 2.2 years (1 to 4 years) after discharge, and endoscopic was rechecked during the followed-up. Results The esophageal symptom of regurgitation, heartburn and dysphagia, as well as the extraesophageal symptom of cough and asthma significantly relieved during followed-up, meanwhile the anti-reflux medication was reduced or stopped in all the patients. For the 4 surgical patient, one had partial recurrence and no complication occurred. Conclusions The management of severe GERD secondary to scleroderma could follow the strategy of controlling the primary disease, living adjustment, anti-reflux medication and surgery step by step. The laparoscopic Toupet fundoplication may be safe, effective and feasible for the medication unmet patients, it deserves further studies.

Citation： HU Zhi-wei, WU Ji-min, WANG Zhong-gao, ZHANG Yu, JI Tao, YAN Chao, DU Xing. Individualized Management of Severe Gastroesophageal Reflux Disease Secondary to Scleroderma: Case Study and Literature Review. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(10): 1214-1219. doi: 10.7507/1007-9424.20160312 Copy

1.	Steen VD, Medsger TA, Jr. Severe organ involvement in systemic sclerosis with diffuse scleroderma. Arthritis Rheum, 2000, 43(11):2437-2444.
2.	Domsic R, Fasanella K, Bielefeldt K. Gastrointestinal manifestations of systemic sclerosis. Dig Dis Sci, 2008, 53(5):1163-1174.
3.	中华医学会风湿病学分会. 系统性硬化病诊治指南(草案). 中华风湿病学杂志, 2004, 8(6):377-379.
4.	Liang WT, Yan C, Wang ZG, et al. Early and midterm outcome after laparoscopic fundoplication and a minimally invasive endoscopic procedure in patients with gastroesophageal reflux disease:a prospective observational study. J Laparoendosc Adv Surg Tech A, 2015, 25(8):657-661.
5.	Vischio J, Saeed F, Karimeddini M, et al. Progression of esophageal dysmotility in systemic sclerosis. J Rheumatol, 2012, 39(5):986-991.
6.	Wang Z, Hu Z, Wu J, et al. Insult of gastroesophageal reflux on airway:clinical significance of pharyngeal nozzle. Front Med, 2014, 9(1):117-122.
7.	Hoshino M, Sundaram A, Srinivasan A, et al. The relationship between dysphagia, pump function, and lower esophageal sphincter pressures on high-resolution manometry. J Gastrointest Surg, 2012, 16(3):495-502.
8.	Briganti V, Oriolo L, Calisti A. Reflux strictures of the oesophagus in children:personal experience with preoperative dilatation followed by anterior funduplication. Pediatr Surg Int, 2003, 19(7):544-547.
9.	Forbes A, Marie I. Gastrointestinal complications:the most frequent internal complications of systemic sclerosis. Rheumatology, 2009, 48 Suppl 3:iii36-iii39.
10.	Lahcene M, Oumnia N, Matougui N, et al. Esophageal involvement in scleroderma:clinical, endoscopic, and manometric features. ISRN Rheumatol, 2011, 2011:325826.
11.	Marie I, Ducrotte P, Denis P, et al. Oesophageal mucosal involvement in patients with systemic sclerosis receiving proton pump inhibitor therapy. Aliment Pharmacol Ther, 2006, 24(11-12):1593-1601.
12.	Martin J, Ferraro P, Duranceau A. Reflux esophagitis and scleroderma. Chest Surg Clin N Am, 2001, 11(3):619-638, viii.
13.	Stefanidis D, Hope WW, Kohn GP, et al. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc, 2010, 24(11):2647-2669.
14.	胡志伟, 汪忠镐, 吴继敏, 等. 胃食管反流病合并食管裂孔疝及哮喘症状的腹腔镜外科治疗. 中华疝和腹壁外科杂志:电子版, 2014, 8(5):396-402.
15.	胡志伟, 汪忠镐, 吴继敏, 等. 胃食管反流相关呼吸疾病及其外科治疗策略. 临床误诊误治, 2013, 26(7):62-66.
16.	Richter JE. Gastroesophageal reflux disease treatment:side effects and complications of fundoplication. Clin Gastroenterol Hepatol, 2013, 11(5):465-471; quiz e439.
17.	Tian ZC, Wang B, Shan CX, et al. A Meta-analysis of randomized controlled trials to compare long-term outcomes of nissen and toupet fundoplication for gastroesophageal reflux disease. PloS One, 2015, 10(6):e0127627.
18.	McCarthy DS, Baragar FD, Dhingra S, et al. The lungs in systemic sclerosis (scleroderma):a review and new information. Semin Arthritis Rheum, 1988, 17(4):271-283.
19.	Savarino E, Bazzica M, Zentilin P, et al. Gastroesophageal reflux and pulmonary fibrosis in scleroderma:a study using. Am J Respir Crit Care Med, 2009, 179(5):408-413.
20.	Liang WT, Wu JN, Wang F, et al. Five-year follow-up of a prospective study comparing laparoscopic Nissen fundoplication with Stretta radiofrequency for gastroesophageal reflux disease. Minerva Chir, 2014, 69(4):217-223.
21.	胡志伟, 汪忠镐, 纪涛, 等. 腹腔镜胃底折叠与食管扩张术治疗儿童胃食管反流病致消化性食管狭窄. 临床误诊误治, 2015, 28(7):74-76.
22.	Hong SK, Vaezi MF. Gastroesophageal reflux monitoring:pH (catheter and capsule) and impedance. Gastrointest Endosc Clin N Am, 2009, 19(1):1-22, v.
23.	O'Leary JP, Hollenbeck JI, Woodward ER. Surgical treatment of esophageal stricture in patients with scleroderma. Am Surg, 1975, 41(3):131-135.
24.	Orringer MB, Orringer JS, Dabich L, et al. Combined Collis gastroplasty-fundoplication operations for scleroderma reflux esophagitis. Surgery, 1981, 90(4):624-630.
25.	Mansour KA, Malone CE. Surgery for scleroderma of the esophagus:a 12-year experience. Ann thorac Surg, 1988, 46(5):513-514.
26.	Nakajima K, Takahashi T, Takiguchi S, et al. Successful laparoscopic Nissen fundoplication in a patient with mixed connective tissue disease with a short esophagus:report of a case. Surg Today, 2013, 43(11):1305-1309.

1. Steen VD, Medsger TA, Jr. Severe organ involvement in systemic sclerosis with diffuse scleroderma. Arthritis Rheum, 2000, 43(11):2437-2444.
2. Domsic R, Fasanella K, Bielefeldt K. Gastrointestinal manifestations of systemic sclerosis. Dig Dis Sci, 2008, 53(5):1163-1174.
3. 中华医学会风湿病学分会. 系统性硬化病诊治指南(草案). 中华风湿病学杂志, 2004, 8(6):377-379.
4. Liang WT, Yan C, Wang ZG, et al. Early and midterm outcome after laparoscopic fundoplication and a minimally invasive endoscopic procedure in patients with gastroesophageal reflux disease:a prospective observational study. J Laparoendosc Adv Surg Tech A, 2015, 25(8):657-661.
5. Vischio J, Saeed F, Karimeddini M, et al. Progression of esophageal dysmotility in systemic sclerosis. J Rheumatol, 2012, 39(5):986-991.
6. Wang Z, Hu Z, Wu J, et al. Insult of gastroesophageal reflux on airway:clinical significance of pharyngeal nozzle. Front Med, 2014, 9(1):117-122.
7. Hoshino M, Sundaram A, Srinivasan A, et al. The relationship between dysphagia, pump function, and lower esophageal sphincter pressures on high-resolution manometry. J Gastrointest Surg, 2012, 16(3):495-502.
8. Briganti V, Oriolo L, Calisti A. Reflux strictures of the oesophagus in children:personal experience with preoperative dilatation followed by anterior funduplication. Pediatr Surg Int, 2003, 19(7):544-547.
9. Forbes A, Marie I. Gastrointestinal complications:the most frequent internal complications of systemic sclerosis. Rheumatology, 2009, 48 Suppl 3:iii36-iii39.
10. Lahcene M, Oumnia N, Matougui N, et al. Esophageal involvement in scleroderma:clinical, endoscopic, and manometric features. ISRN Rheumatol, 2011, 2011:325826.
11. Marie I, Ducrotte P, Denis P, et al. Oesophageal mucosal involvement in patients with systemic sclerosis receiving proton pump inhibitor therapy. Aliment Pharmacol Ther, 2006, 24(11-12):1593-1601.
12. Martin J, Ferraro P, Duranceau A. Reflux esophagitis and scleroderma. Chest Surg Clin N Am, 2001, 11(3):619-638, viii.
13. Stefanidis D, Hope WW, Kohn GP, et al. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc, 2010, 24(11):2647-2669.
14. 胡志伟, 汪忠镐, 吴继敏, 等. 胃食管反流病合并食管裂孔疝及哮喘症状的腹腔镜外科治疗. 中华疝和腹壁外科杂志:电子版, 2014, 8(5):396-402.
15. 胡志伟, 汪忠镐, 吴继敏, 等. 胃食管反流相关呼吸疾病及其外科治疗策略. 临床误诊误治, 2013, 26(7):62-66.
16. Richter JE. Gastroesophageal reflux disease treatment:side effects and complications of fundoplication. Clin Gastroenterol Hepatol, 2013, 11(5):465-471; quiz e439.
17. Tian ZC, Wang B, Shan CX, et al. A Meta-analysis of randomized controlled trials to compare long-term outcomes of nissen and toupet fundoplication for gastroesophageal reflux disease. PloS One, 2015, 10(6):e0127627.
18. McCarthy DS, Baragar FD, Dhingra S, et al. The lungs in systemic sclerosis (scleroderma):a review and new information. Semin Arthritis Rheum, 1988, 17(4):271-283.
19. Savarino E, Bazzica M, Zentilin P, et al. Gastroesophageal reflux and pulmonary fibrosis in scleroderma:a study using. Am J Respir Crit Care Med, 2009, 179(5):408-413.
20. Liang WT, Wu JN, Wang F, et al. Five-year follow-up of a prospective study comparing laparoscopic Nissen fundoplication with Stretta radiofrequency for gastroesophageal reflux disease. Minerva Chir, 2014, 69(4):217-223.
21. 胡志伟, 汪忠镐, 纪涛, 等. 腹腔镜胃底折叠与食管扩张术治疗儿童胃食管反流病致消化性食管狭窄. 临床误诊误治, 2015, 28(7):74-76.
22. Hong SK, Vaezi MF. Gastroesophageal reflux monitoring:pH (catheter and capsule) and impedance. Gastrointest Endosc Clin N Am, 2009, 19(1):1-22, v.
23. O'Leary JP, Hollenbeck JI, Woodward ER. Surgical treatment of esophageal stricture in patients with scleroderma. Am Surg, 1975, 41(3):131-135.
24. Orringer MB, Orringer JS, Dabich L, et al. Combined Collis gastroplasty-fundoplication operations for scleroderma reflux esophagitis. Surgery, 1981, 90(4):624-630.
25. Mansour KA, Malone CE. Surgery for scleroderma of the esophagus:a 12-year experience. Ann thorac Surg, 1988, 46(5):513-514.
26. Nakajima K, Takahashi T, Takiguchi S, et al. Successful laparoscopic Nissen fundoplication in a patient with mixed connective tissue disease with a short esophagus:report of a case. Surg Today, 2013, 43(11):1305-1309.

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Individualized Management of Severe Gastroesophageal Reflux Disease Secondary to Scleroderma: Case Study and Literature Review

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