Esophageal manifestation in patients with scleroderma

Table 1 Studies assessing per os pharmacotherapy in patients with systemic sclerosis and esophageal involvement

Ref.	Patients (n)	Treatment	Treatment duration	Response to treatment
Hendel et al[63], 1992	25	Omeprazole 20-80 mg (adjustments of the maintenance dose of omeprazole	Mean time of 40 mo	Healing of esophagitis in almost 50% patients
Marie et al[34], 2006	133	Omeprazole 20-40 mg	Mean duration of 6 yr from treatment initiation	Heartburn (n = 103; 77.4%), dysphagia (n = 19; 14.3%)
				Improvement of heartburn: (77.4%)
				Improvement of dysphagia: (14.3%)
				Esophagitis healing: 32.3%
Pakozdi et al[64], 2009	21	Lansoprazole 30 mg	12 mo	Short-term (6 mo) efficacy in decreasing frequency of symptoms in
				No long-term benefit
Muro et al[65], 2009	84	Rabeprazole 10 mg	8 wk	Effective for the symptom control
Foocharoen et al[67], 2017	148	Omeprazole 20 bid	4 wk	40.1% responded to omeprazole
	88	Omeprazole + domperidone (n = 38)/aglycon (n = 37)		Domperidone and algycon are equally effective treatments when used in combination with omeprazole
				17% of patients were nonresponsive
Stern et al[55], 2018	38	Twice daily different PPIs (rabeprazole, dexlansoprazole, esomeprazole, omeprazole, lansoprazole, pantoprazole)-variable dosing schedules	Treatment duration not given	Despite PPIs high-dose:
				61% of SSc patients had an AET ≥ 4.5%
				55% of SSc patients had an AET > 6%
Foocharoen et al[54], 2020	243	Omeprazole 20 mg bid	4 wk	PPI-partial response: 53.9%
Tabuchi et al[72], 2021	15 (14/15 with PPI-partial response)	Vonoprazan 10-20 mg	> 2 yr	Symptom relief in 83.4%
				Long-term symptom control in 87%
Johnson et al[77], 1987	12	Metoclopramide 10 mg Χ 2	1 wk from treatment initiation	Significant reduction of reflux events: in 91.6%
				All but 2 patients attained LES pressure values that fell in the normal range after metoclopramide treatment
Karamanolis et al[84], 2016	22	Buspirone 20 mg	4 wk	Improvement in the severity of heartburn: 70%
				Improvement in the severity of regurgitation in 58%
				Improvement in dysphagia in 50% and in chest pain in 25%

AET: Acid exposure times; bid: Twice a day; LES: Lower esophageal sphincter; PPIs: Proton pump inhibitors; SSc: Systemic sclerosis.