Esophageal dilatation and interstitial lung disease in systemic sclerosis: A cross-sectional study

Carrie Richardson; Rishi Agrawal; Jungwha Lee; Orit Almagor; Ryan Nelson; John Varga; Michael J. Cuttica; Jane D′Amico Dematte; Rowland W. Chang; Monique E. Hinchcliff

doi:10.1016/j.semarthrit.2016.02.004

Esophageal dilatation and interstitial lung disease in systemic sclerosis: A cross-sectional study

Carrie Richardson, Rishi Agrawal, Jungwha Lee, Orit Almagor, Ryan Nelson, John Varga, Michael J. Cuttica, Jane D′Amico Dematte, Rowland W. Chang, Monique E. Hinchcliff^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

56 Scopus citations

Abstract

Objective A patulous esophagus on high-resolution computed tomography (HRCT) of the thorax is frequently observed in patients with systemic sclerosis (SSc). Microaspiration has been purported to play a role in the development and progression of SSc interstitial lung disease (ILD), but studies examining the role of microaspiration in SSc ILD have yielded conflicting results. This study was conducted to determine the association between esophageal diameter and SSc ILD. Methods A cross-sectional study of Northwestern Scleroderma Registry patients with available HRCT exams was conducted. The predictor variable was the widest esophageal diameter (WED) on HRCT, and the primary and secondary outcome variables were radiographic ILD and pulmonary function tests respectively. The degree of radiographic ILD was assessed using a semi-quantitative score adapted from published methods. Estimated regression coefficients adjusted for age, sex, race, body mass index, smoking; SSc disease subtype, serum autoantibodies, and disease duration; modified Rodnan skin score, proton pump inhibitor, and immune suppressant medication use and erythrocyte sedimentation rate were calculated. Results A total of 270 subjects were studied. In the adjusted analyses, there were positive associations between WED and total ILD score (β = 0.27; 95% CI: 0.09–0.41), fibrosis (β = 0.15; 95% CI: 0.07–0.23), and ground glass opacities (β = 0.12; 95% CI: 0.04–0.20); there were negative associations between WED and FVC % predicted (β = −0.42; 95% CI: −0.69 to −0.13), and adjusted DLCO % predicted (β = −0.45; 95% CI: −0.80 to −0.09) after adjusting for potential confounders. Conclusions Increasing esophageal diameter on HRCT in patients with SSc is associated with more severe radiographic ILD, lower lung volumes, and lower DLCO % predicted. Longitudinal studies are needed to determine if esophageal dilatation is associated with the incidence and/or progression of ILD in patients with SSc.

Original language	English (US)
Pages (from-to)	109-114
Number of pages	6
Journal	Seminars in Arthritis and Rheumatism
Volume	46
Issue number	1
DOIs	https://doi.org/10.1016/j.semarthrit.2016.02.004
State	Published - Aug 1 2016

Funding

This work was supported in part by a NIH-NIAMS K23 AR059763 and a research award from the Scleroderma Research Foundation, United States (M.H.) by NIH-NIAMS P60 AR064464 (R.W.C., J.L., O.A.) and NCATS-CTSA UL1TR000150 (J.L.).

Keywords

Dilation
Esophagus
Interstitial lung disease
Pulmonary fibrosis
Systemic sclerosis

ASJC Scopus subject areas

Rheumatology
Anesthesiology and Pain Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.semarthrit.2016.02.004

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@article{1463dd18153a440ab70a7967c8556a47,

title = "Esophageal dilatation and interstitial lung disease in systemic sclerosis: A cross-sectional study",

abstract = "Objective A patulous esophagus on high-resolution computed tomography (HRCT) of the thorax is frequently observed in patients with systemic sclerosis (SSc). Microaspiration has been purported to play a role in the development and progression of SSc interstitial lung disease (ILD), but studies examining the role of microaspiration in SSc ILD have yielded conflicting results. This study was conducted to determine the association between esophageal diameter and SSc ILD. Methods A cross-sectional study of Northwestern Scleroderma Registry patients with available HRCT exams was conducted. The predictor variable was the widest esophageal diameter (WED) on HRCT, and the primary and secondary outcome variables were radiographic ILD and pulmonary function tests respectively. The degree of radiographic ILD was assessed using a semi-quantitative score adapted from published methods. Estimated regression coefficients adjusted for age, sex, race, body mass index, smoking; SSc disease subtype, serum autoantibodies, and disease duration; modified Rodnan skin score, proton pump inhibitor, and immune suppressant medication use and erythrocyte sedimentation rate were calculated. Results A total of 270 subjects were studied. In the adjusted analyses, there were positive associations between WED and total ILD score (β = 0.27; 95% CI: 0.09–0.41), fibrosis (β = 0.15; 95% CI: 0.07–0.23), and ground glass opacities (β = 0.12; 95% CI: 0.04–0.20); there were negative associations between WED and FVC % predicted (β = −0.42; 95% CI: −0.69 to −0.13), and adjusted DLCO % predicted (β = −0.45; 95% CI: −0.80 to −0.09) after adjusting for potential confounders. Conclusions Increasing esophageal diameter on HRCT in patients with SSc is associated with more severe radiographic ILD, lower lung volumes, and lower DLCO % predicted. Longitudinal studies are needed to determine if esophageal dilatation is associated with the incidence and/or progression of ILD in patients with SSc.",

keywords = "Dilation, Esophagus, Interstitial lung disease, Pulmonary fibrosis, Systemic sclerosis",

author = "Carrie Richardson and Rishi Agrawal and Jungwha Lee and Orit Almagor and Ryan Nelson and John Varga and Cuttica, {Michael J.} and Dematte, {Jane D′Amico} and Chang, {Rowland W.} and Hinchcliff, {Monique E.}",

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year = "2016",

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doi = "10.1016/j.semarthrit.2016.02.004",

language = "English (US)",

volume = "46",

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TY - JOUR

T1 - Esophageal dilatation and interstitial lung disease in systemic sclerosis

T2 - A cross-sectional study

AU - Richardson, Carrie

AU - Agrawal, Rishi

AU - Lee, Jungwha

AU - Almagor, Orit

AU - Nelson, Ryan

AU - Varga, John

AU - Cuttica, Michael J.

AU - Dematte, Jane D′Amico

AU - Chang, Rowland W.

AU - Hinchcliff, Monique E.

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Objective A patulous esophagus on high-resolution computed tomography (HRCT) of the thorax is frequently observed in patients with systemic sclerosis (SSc). Microaspiration has been purported to play a role in the development and progression of SSc interstitial lung disease (ILD), but studies examining the role of microaspiration in SSc ILD have yielded conflicting results. This study was conducted to determine the association between esophageal diameter and SSc ILD. Methods A cross-sectional study of Northwestern Scleroderma Registry patients with available HRCT exams was conducted. The predictor variable was the widest esophageal diameter (WED) on HRCT, and the primary and secondary outcome variables were radiographic ILD and pulmonary function tests respectively. The degree of radiographic ILD was assessed using a semi-quantitative score adapted from published methods. Estimated regression coefficients adjusted for age, sex, race, body mass index, smoking; SSc disease subtype, serum autoantibodies, and disease duration; modified Rodnan skin score, proton pump inhibitor, and immune suppressant medication use and erythrocyte sedimentation rate were calculated. Results A total of 270 subjects were studied. In the adjusted analyses, there were positive associations between WED and total ILD score (β = 0.27; 95% CI: 0.09–0.41), fibrosis (β = 0.15; 95% CI: 0.07–0.23), and ground glass opacities (β = 0.12; 95% CI: 0.04–0.20); there were negative associations between WED and FVC % predicted (β = −0.42; 95% CI: −0.69 to −0.13), and adjusted DLCO % predicted (β = −0.45; 95% CI: −0.80 to −0.09) after adjusting for potential confounders. Conclusions Increasing esophageal diameter on HRCT in patients with SSc is associated with more severe radiographic ILD, lower lung volumes, and lower DLCO % predicted. Longitudinal studies are needed to determine if esophageal dilatation is associated with the incidence and/or progression of ILD in patients with SSc.

AB - Objective A patulous esophagus on high-resolution computed tomography (HRCT) of the thorax is frequently observed in patients with systemic sclerosis (SSc). Microaspiration has been purported to play a role in the development and progression of SSc interstitial lung disease (ILD), but studies examining the role of microaspiration in SSc ILD have yielded conflicting results. This study was conducted to determine the association between esophageal diameter and SSc ILD. Methods A cross-sectional study of Northwestern Scleroderma Registry patients with available HRCT exams was conducted. The predictor variable was the widest esophageal diameter (WED) on HRCT, and the primary and secondary outcome variables were radiographic ILD and pulmonary function tests respectively. The degree of radiographic ILD was assessed using a semi-quantitative score adapted from published methods. Estimated regression coefficients adjusted for age, sex, race, body mass index, smoking; SSc disease subtype, serum autoantibodies, and disease duration; modified Rodnan skin score, proton pump inhibitor, and immune suppressant medication use and erythrocyte sedimentation rate were calculated. Results A total of 270 subjects were studied. In the adjusted analyses, there were positive associations between WED and total ILD score (β = 0.27; 95% CI: 0.09–0.41), fibrosis (β = 0.15; 95% CI: 0.07–0.23), and ground glass opacities (β = 0.12; 95% CI: 0.04–0.20); there were negative associations between WED and FVC % predicted (β = −0.42; 95% CI: −0.69 to −0.13), and adjusted DLCO % predicted (β = −0.45; 95% CI: −0.80 to −0.09) after adjusting for potential confounders. Conclusions Increasing esophageal diameter on HRCT in patients with SSc is associated with more severe radiographic ILD, lower lung volumes, and lower DLCO % predicted. Longitudinal studies are needed to determine if esophageal dilatation is associated with the incidence and/or progression of ILD in patients with SSc.

KW - Dilation

KW - Esophagus

KW - Interstitial lung disease

KW - Pulmonary fibrosis

KW - Systemic sclerosis

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Esophageal dilatation and interstitial lung disease in systemic sclerosis: A cross-sectional study

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UN SDGs

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