Does long term therapy with lansoprazole slow progression of oesophageal involvement in systemic sclerosis?

Oesophageal scintigraphy is an effective, non-invasive screening test to detect oesophageal dysmotility and reflux. Our objective was to assess the long term effect of lansoprazole therapy on gastroesophageal dysmotility in systemic sclerosis (SSc).

24 SSc patients were randomised to receive either lansoprazole 30 mg or placebo for 12 months. Gastroesophageal motility was assessed by scintigraphy at baseline, after 6 months and after 12 months. Symptoms were evaluated by self-reported gastrointestinal questionnaire.

Of 21 patients starting treatment, 17 (81%) completed the first 6 months and 13 (62%) completed the study. 3 patients from each group were withdrawn due to adverse events. As expected, lansoprazole appeared to decrease frequency of gastroesophageal symptoms in the first 6 months of treatment, but long term benefit was not evident. Scintigraphy showed worsening oesophageal dysmotility in SSc patients irrespective of lansoprazole treatment. In addition, early signs of dysmotility were found in asymptomatic patients. We found no correlation of scintigraphy findings with symptoms of gastroesophageal dysmotility.

Although lansoprazole 30 mg daily appears to suppress SSc-related gastroesophageal symptoms in the short term, benefit was not sustained at 12 months, and there was no evidence that progression of gastroesophageal motility was prevented. Scintigraphy findings did not correlate with symptoms of dysphagia.