Abstract Rationale Systemic sclerosis (SSc) is an autoimmune disorder characterized by skin thickening, microvascular angiopathy, and visceral organ fibrosis. The gastrointestinal tract is the most commonly involved visceral organ system, causing gastroesophageal reflux (GER), esophageal dysmotility, and delayed gastric emptying in up to 90% of patients. Pulmonary disease, one of the most morbid visceral complications, manifests as interstitial lung disease and/or pulmonary arterial hypertension, and severe cases require lung transplant for definitive treatment. This multisystem involvement complicates the pre- and post-transplant course. Esophageal dysmotility and GER are thought to increase aspiration risk and, therefore, the risk of graft dysfunction, in some cases portending ineligibility for transplant. Early identification, treatment, and risk stratification of aspiration in scleroderma patients is challenging, often relying on ambulatory pH impedance monitoring (via the DeMeester score), and esophageal manometry (via the respiratory-mean basal lower esophageal pressure, hereafter LESP). However, the true clinical utility and predictive value of these methods are not well studied. Methods Twenty lung transplant patients with definitive evidence of aspiration on routine post-transplant surveillance biopsy were selected and matched with 31 controls without biopsy-proven aspiration. Ambulatory pH impedance and esophageal manometry were examined, along with routine demographic data including sex, transplant indication, and survival. Multiple linear regression with ANOVA and multiple logistic regression models were applied to study the association of pH impedance testing (via DeMeester score) and manometry (via LESP) with biopsy-proven aspiration, as well as with overall survival and survival after transplant. Results The sample contained 14 patients with SSc and 37 patients with other lung diseases (COPD, A1AT deficiency, IPF, sarcoidosis, and MCTD-ILD). Aspiration was significantly associated with decreased overall survival in years (p = 0.001, R2 = 72.26%) but not associated with survival after transplant (p = 0.354, R2 = 21.91%) (t = -1.82, p(t) = 0.076). Aspiration was not significantly predicted by either DeMeester score ≥14.72 (OR 0.33-6.76, p = 0.079) or LESP 10 mmHg (OR 0.51-14.31, p = 0.272). This finding held among patients with and without scleroderma. Conclusions This study questions the utility of pH impedance and esophageal manometry testing in evaluating SSc patients’ risk of aspiration. Utilizing biopsy, a relatively strict parameter for aspiration, does establish a higher threshold of significance, but the ubiquity of these diagnostic measures necessitates further rigorous evaluation of the utility of these measures and exploration of alternatives. This abstract is funded by: None
Smith et al. (Fri,) studied this question.