ABSTRACT Objectives: Proton Pump Inhibitors (PPIs) are widely used in SSc for gastroesophageal reflux disease (GERD). However, there is little evidence to support their empirical use and long-term safety has been questioned. Our objective was to better describe clinicians’ attitudes toward PPIs prescription and use in SSc patients. Methods: Clinicians involved in the care of SSc patients were invited through international physician networks and social media to participate in an online survey. Results: Responses from 227 clinicians from 36 countries were evaluable. The majority ‘agreed’ (41.4 %) or ‘strongly agreed’ (45.4 %) that GERD is a major cause of morbidity in SSc. Lifestyle modifications are seldom (16 %) considered effective. Only half ‘agreed’ (43 %) or ‘strongly agreed’ (11 %) there is solid evidence supporting PPIs efficacy in SSc. The most common reasons for PPIs prescription were symptomatic GERD unresponsive to lifestyle modification (95 %), objective evidence of GERD (82 %), and hoarseness or respiratory symptoms (71 %). There are variable concerns about PPIs long-term safety in SSc. The three highest (mean) reasons (0–10, here 10 is ‘very concerned’) were: small intestinal bacterial overgrowth (5.5), osteoporosis (5.4), and drug interactions (5.2). There are significant differences in attitudes towards surgery for refractory GERD, and concerns about potential complications. PPIs may have a putative role for disease modification (e.g., ILD and calcinosis), and the role of immunosuppression is uncertain for GI (gastrointestinal) disease in SSc. Conclusion: PPIs are frequently prescribed in SSc. Side effects are a recognized concern, especially regarding longterm therapy. There is significant variation in attitudes towards surgical intervention. Future research and practical treatment recommendation for PPIs in SSc are urgently needed.
A multi-national survey to identify clinicians' perspectives concerning Proton Pump inhibitors in patients with systemic sclerosis / Giulia Bandini a , Alessia Alunno b , Filipe Oliveira Pinheiro c , Corrado Campochiaro d , Ilaria Galetti e , Pietro Matucci Cerinic f , Barbara Ruaro g , Alberto Moggi Pignone a , Silvia Bellando Randone h , Lorenzo Dagna d , Marco Matucci Cerinic d,h , Zsuzsanna H McMahan i , Michael Hughes. - In: SEMINARS IN ARTHRITIS AND RHEUMATISM. - ISSN 0049-0172. - ELETTRONICO. - 67:(2024), pp. 152419.1-152419.7. [10.1016/j.semarthrit.2024.152419]
A multi-national survey to identify clinicians' perspectives concerning Proton Pump inhibitors in patients with systemic sclerosis
Alberto Moggi Pignone a;
2024
Abstract
ABSTRACT Objectives: Proton Pump Inhibitors (PPIs) are widely used in SSc for gastroesophageal reflux disease (GERD). However, there is little evidence to support their empirical use and long-term safety has been questioned. Our objective was to better describe clinicians’ attitudes toward PPIs prescription and use in SSc patients. Methods: Clinicians involved in the care of SSc patients were invited through international physician networks and social media to participate in an online survey. Results: Responses from 227 clinicians from 36 countries were evaluable. The majority ‘agreed’ (41.4 %) or ‘strongly agreed’ (45.4 %) that GERD is a major cause of morbidity in SSc. Lifestyle modifications are seldom (16 %) considered effective. Only half ‘agreed’ (43 %) or ‘strongly agreed’ (11 %) there is solid evidence supporting PPIs efficacy in SSc. The most common reasons for PPIs prescription were symptomatic GERD unresponsive to lifestyle modification (95 %), objective evidence of GERD (82 %), and hoarseness or respiratory symptoms (71 %). There are variable concerns about PPIs long-term safety in SSc. The three highest (mean) reasons (0–10, here 10 is ‘very concerned’) were: small intestinal bacterial overgrowth (5.5), osteoporosis (5.4), and drug interactions (5.2). There are significant differences in attitudes towards surgery for refractory GERD, and concerns about potential complications. PPIs may have a putative role for disease modification (e.g., ILD and calcinosis), and the role of immunosuppression is uncertain for GI (gastrointestinal) disease in SSc. Conclusion: PPIs are frequently prescribed in SSc. Side effects are a recognized concern, especially regarding longterm therapy. There is significant variation in attitudes towards surgical intervention. Future research and practical treatment recommendation for PPIs in SSc are urgently needed.
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