Prevalence and Risk Factors for Esophageal Strictures in Systemic Sclerosis

Objective Gastroesophageal reflux disease (GERD) affects up to 90% of patients with systemic sclerosis (SSc). Chronic esophageal acid exposure can result in complications including the formation of esophageal strictures (ES). Proton pump inhibitors can alter gastric acid pH and improve GORD symptoms; however, there have been no recent studies evaluating the prevalence of SSc–ES since these medications became widely available. Our aim was to investigate the prevalence of SSc–ES over time and identify risk factors associated with ES. Methods Consecutive patients from the Australian Scleroderma Cohort Study who met American College of Rheumatology/EULAR criteria for SSc were included. Clinically significant ES was defined as characteristic findings seen on gastroscopy or patient‐reported ES requiring dilatation. Multivariable logistic regression analysis was used to identify factors associated with SSc–ES. The time to SSc–ES development from SSc disease onset was evaluated using Kaplan‐Meier survival analysis. Results ES affected 191 of 1,543 patients (12.4%) and were associated with a longer disease duration, gastric antral vascular ectasia, esophageal dysmotility, reflux esophagitis, and myocardial disease on multivariable logistic regression analysis ( P < 0.05). Compared to patients with SSc diagnosed before 1990, those who were diagnosed between 2000 and 2010 and 2010 and 2023 were significantly less likely to have clinically significant ES on multivariable logistic regression analysis (odds ratio 0.45 and 0.42, respectively; P = 0.002).The median disease duration at time of SSc–ES diagnosis increased from 3 (interquartile range 0–5) years to 11.5 (interquartile range 3.5–24) years for those diagnosed with SSc–ES before 1990 to those diagnosed after 2010 ( P = 0.0027). Conclusion SSc–ES is associated with a longer disease duration and other gastrointestinal SSc manifestations, with prevalence decreasing over time.