The extent and pattern of gastro-oesophageal reflux in patients with scleroderma oesophagus: the effect of low-dose omeprazole.

Ambulatory 24-hour oesophageal pH studies were obtained from 11 patients with scleroderma who expressed either dysphagia (n = 6) or heartburn (n = 5) as their predominant oesophageal symptom. No significant differences were found in the extent of pattern of reflux between these two groups. The pH data of both scleroderma groups were combined and compared to an age- and sex-matched group of control subjects (n = 11). The reflux demonstrated by scleroderma patients was significantly greater than the control group in every category (P < 0.01). The percentage of time the pH was < 4.0 was not significantly different (P > 0.05) upright (29.9 +/- 19.8%) vs. supine (44.2 +/- 28.5%) in patients with scleroderma. Eight scleroderma patients underwent repeat pH studies while taking low-dose omeprazole (20 mg daily) and reflux was reduced significantly (P < 0.01) in all patients. The authors believe that 24-hour ambulatory oesophageal pH-monitoring should be routinely conducted in scleroderma patients to provide quantitative reflux data, even when heartburn is not expressed as a symptom. Omeprazole, 20 mg daily, provides adequate protection from the H+ component of the refluxate.