{
  "abstract": "Background Gastro-oesophageal reflux disease (GORD) occurs in most (∼75%) patients with systemic sclerosis (SSc) and significantly impacts quality of life. Current recommendations lack depth and therefore our aim was to produce practical, consensus-based recommendations for refractory SSc-related GORD.Methods An international, multidisciplinary steering board (SB) was assembled (n=19) consisting of clinicians (rheumatologists, gastroenterologists, gastrointestinal surgeons), an expert methodologist and patient representation. After reviewing the latest definitions of GORD and refractory GORD in the published literature, the SB collectively devised a practical definition of SSc refractory-GORD. Initial recommendations were drafted/agreed on by the SB based on review of the existing guidelines, published literature and expert opinion. Two online voting rounds were conducted to determine whether items should be accepted, with >75% and >60% SB agreement required for first and second rounds, respectively.Results There was a good response/completion rate for the initial (74%) and final (84%) voting rounds. The SB agreed on all 36 draft recommendations. The majority (n=34) were approved in the first round. Recommendations were organised according to the following categories: general approach to management (n=5), assessment (n=6), non-pharmacological (n=2) and pharmacological (n=10) management, endoscopic and surgical treatment (n=3), and special circumstances including refractory GORD and SSc-interstitial lung disease (n=3), myositis and SSc connective tissue disease-overlap (n=3) and perilung transplant (n=4).Conclusion The group of experts has drafted extended and practical recommendations for the management of SSc refractory-GORD. The necessity of a structured approach and a patient assessment is highlighted in order to provide a multidisciplinary approach to the tailored choice of the treatment. Our work also has also identified significant unmet needs and has provided a research agenda to advance the field.",
  "authors": [
    {
      "affiliations": [
        "The University of Manchester Centre for Musculoskeletal Research, Manchester, UK",
        "Department of Rheumatology, Northern Care Alliance NHS Foundation Trust, Salford, UK",
        "NIHR Manchester Biomedical Research Centre, Manchester, UK"
      ],
      "name": "Michael Hughes"
    },
    {
      "affiliations": [
        "Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy"
      ],
      "name": "Anna Lo Cricchio"
    },
    {
      "affiliations": [
        "Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy"
      ],
      "name": "Maria Cristina De Santis"
    },
    {
      "affiliations": [
        "Digestive System Research Unit, Digestive Diseases Department, Vall d’Hebron University Hospital, Barcelona, Spain"
      ],
      "name": "Luis G Alcala-Gonzalez"
    },
    {
      "affiliations": [
        "Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA"
      ],
      "name": "John Clarke"
    },
    {
      "affiliations": [
        "Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK",
        "The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK"
      ],
      "name": "Alexander O’Connor"
    },
    {
      "affiliations": [
        "Department of Experimental and Clinical Medicine, Division of Rheumatology, Scleroderma Unit, University of Florence, Firenze, Italy"
      ],
      "name": "Silvia Bellando Randone"
    },
    {
      "affiliations": [
        "Centre for Rheumatology and Connective Tissue Diseases, University College London Medical School, London, UK"
      ],
      "name": "Christopher Denton"
    },
    {
      "affiliations": [
        "Federation of European Scleroderma Associations (FESCA) Belgium, GILS (Gruppo Italiano, Lotta alla Sclerodermia (Italy), Milan, Italy"
      ],
      "name": "Ilaria Galetti"
    },
    {
      "affiliations": [
        "Inserm, EHESP, Irset -Institut de Recherche en Santé, Environnement et Travail-UMRS, University of Rennes CHU Rennes, Rennes, France",
        "Department of Internal Medicine and Clinical Immunology, CHU de Rennes, Rennes, France"
      ],
      "name": "Alain Lescoat"
    },
    {
      "affiliations": [
        "Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), and Inflammation, fibrosis and ageing initiative (INFLAGE), IRCCS Ospedale San Raffaele, Milan, Italy",
        "Vita-Salute San Raffaele University, Milan, Italy",
        "Inflammation Fibrosis and Ageing Initiative (INFLAGE), Division of Genetics and Cell Biology, IRCCS Ospedale San Raffaele, Milan, Italy"
      ],
      "name": "Marco Matucci-Cerinic"
    },
    {
      "affiliations": [
        "Division of Surgery and Transplantation, Department of Surgery, University of Udine, Udine, Italy"
      ],
      "name": "Pietro Matucci-Cerinic"
    },
    {
      "affiliations": [
        "The University of Manchester and Salford Royal NHS Foundation Trust, Manchester, UK"
      ],
      "name": "John Mclaughlin"
    },
    {
      "affiliations": [
        "Gastroenterology, Cleveland Clinic Digestive Disease and Surgery Institute, Cleveland, UK"
      ],
      "name": "Charles Murray"
    },
    {
      "affiliations": [
        "Center for Neurogastroenterology, Johns Hopkins, Baltimore, Maryland, USA",
        "Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA"
      ],
      "name": "Pankaj J Pasricha"
    },
    {
      "affiliations": [
        "Division of Rheumatology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA"
      ],
      "name": "Elizabeth R Volkmann"
    },
    {
      "affiliations": [
        "Internal Medicine and Nephrology Division, University of L’Aquila Department of Clinical Medicine Life Health and Environmental Sciences, ASL1 Avezzano-Sulmona-L'Aquila, L’Aquila, Italy"
      ],
      "name": "Alessia Alunno"
    },
    {
      "affiliations": [
        "Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy"
      ],
      "name": "Giulia Bandini"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Rheumatology, UTHealth Houston, Houston, Texas, USA"
      ],
      "name": "Zsuzsanna H McMahan"
    }
  ],
  "title": "Expert recommendations for the management of refractory gastro-oesophageal reflux disease in systemic sclerosis: a report from the World Scleroderma Foundation (WSF) Gastrointestinal ‘Ad hoc committee’",
  "uid": "32dd708d-7d94-5ca7-81d6-f8a296c6750e"
}