Sirs, We read with interest the study by Marie et al. which showed that, in a cross-sectional study with 133 systemic sclerosis (SSc) patients, 43 patients (32%) had oesophagitis and nine (7%) had histological Barrett’s oesophagus (BE). These authors suggested that oesophagitis/BE and BE alone patients had more frequently dysphagia and nausea/vomiting.1 The prevalence of severe oesophageal motor disorders (stage IV) on manometry was higher in patients with BE.
We recently found a prevalence of BE in SSc of 13%2 but could not identify clinical or manometric risk factors with the exception of Helicobacter pylori which was not investigated in the study herein. Previous risk factors of BE included sex, age, obesity3 and decreased oesophageal sphincter pressure (<6 mmHg).4 The lack of detail of manometry results in Marie et al. study precludes clear conclusion and this should be further clarified. Moreover, the evaluation of symptoms taking into account only one time point and after discontinuation of usual medication that might affect oesophageal motility introduces confounding factors regarding this association and translation into practice. BE sub-population is unfortunately poorly described and pooling BE and oesophagitis patients for analysis is questionable. Defining the SSc patients at risk of BE remains a crucial challenge in regard to the recently described high risk of oesophageal adenocarcinoma in SSc.5 Only a prospective study will allow the determination of the link between BE and adenocarcinoma risk in SSc and that is ongoing supported by the EULAR Scleroderma Trials and Research group (http://www.eustar.org). In addition, regarding the link between pulmonary involvement and oesophageal disturbances, the data could be strengthened using a multivariate analysis taking into account the pulmonary status for the determination of associated factors; this would allow the estimation of the weight of oesophageal involvement compared with other parameters.