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GORD in Systemic Sclerosis — SCE Palliative Medicine MCQ

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ModerateNon-Malignant Palliative CareGORD in Systemic SclerosisSCE Palliative Medicine

A 60‑year‑old woman with advanced systemic sclerosis has severe GORD from oesophageal dysmotility. She is on maximum‑dose PPI (lansoprazole 30 mg BD) with persistent symptoms. What additional measure may help?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Add prokinetic therapy (e.g. domperidone or metoclopramide before meals) plus lifestyle measures (elevated head‑of‑bed, small frequent meals)

Explanation lettering: D = shown as A · A = shown as B · B = shown as C · C = shown as D

This question tests understanding that reflux in SSc is driven by dysmotility rather than acid hypersecretion. EULAR (2024) explicitly recommends considering prokinetics in symptomatic motility disturbances in SSc, in addition to PPI therapy. A recent specialist review confirms prokinetics are commonly used as add‑on therapy in PPI‑refractory SSc‑GORD. The NHS Specialist Pharmacy Service advises lifestyle modifications first, then prokinetics (domperidone or metoclopramide) as second‑line. Fundoplication is ill‑advised due to SSc tissue healing issues, intensifying acid suppression (B, C) or withdrawing therapy (D) miss the dysmotility pathophysiology. Thus E is uniquely appropriate.

Reference: EULAR recommendations for the treatment of systemic sclerosis 2023 update (2024); Esophageal manifestation in systemic sclerosis – add‑on prokinetics (2023); NHS Specialist Pharmacy Service on prokinetics (2025).