J Rheum Dis 2019; 26(1): 66-73  
Endoscopic Features of Upper Gastrointestinal Tract in Patients with Systemic Sclerosis Compared to the Healthy Control
Jun Won Park1, Jihye Kim2,3, Eun Ae Kang3, Min Jung Kim1, Joo Sung Kim3, Eun Bong Lee1
1Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, 2Department of Internal Medicine, CHA Gangnam Medical Center, CHA University School of Medicine, 3Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
Correspondence to: Eun Bong Lee http://orcid.org/0000-0003-0703-1208 Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. E-mail:leb7616@snu.ac.kr
Received: November 24, 2018; Revised: November 29, 2018; Accepted: November 30, 2018; Published online: January 1, 2019.
© Korean College of Rheumatology. All rights reserved.

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Abstract
Objective. To characterize the endoscopic features of upper gastrointestinal tract in patients with systemic sclerosis (SSc) compared with those in the healthy controls. Methods. Data on esophagogastroduodenoscopy (EGD) in 180 patients with SSc (SSc group) were compared with that from the 181 age- and sex-matched healthy control who underwent EGD for routine check-up (control group). Clinical data of participants at the time of EGD (defined as baseline) were collected from electric medical record. Endoscopic findings were evaluated by two experts with blinded to their clinical features. Primary outcome of the study was prevalence of each endoscopic lesion between the two groups. Results. The mean±standard deviation age and disease duration in the SSc group at baseline were 55.3±11.8 and 2.9±3.7 years, respectively. Compared to the control group, SSc group more frequently showed reflux esophagitis (32.8% vs. 9.4%, p<0.001). In contrast, prevalence of atrophic gastritis was significantly lower in the SSc group (8.3% vs. 29.3%, p<0.001). This result was consistent in the multivariable analysis where patients’ age and concomitant proton pump inhibitor use were adjusted. There was no case of gastric antral vascular ectasia (GAVE) in both groups. However, 29 (16.1%) patients in SSc group showed a clinically significant anemia (hemoglobin <10 mg/dL), with none of the endoscopic features showed significant associations with the outcome. Conclusion. Patients with SSc showed significantly lower prevalence of atrophic gastritis. There was no case of GAVE, which suggests that clinical phenotype of the SSc could be different according to the ethnicity or geographic region.
Keywords: Scleroderma, systemic, Endoscopy, Gastritis, Gastric antral vascular ectasia


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