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SSc GI Management — SCE Rheumatology MCQ

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EasySystemic SclerosisSSc GI ManagementSCE Rheumatology

A 48-year-old woman with systemic sclerosis has persistent nocturnal gastro-oesophageal reflux despite optimised proton-pump inhibitor therapy. Which lifestyle advice is the most appropriate adjunctive measure?

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Correct answer: E — Raise the head of the bed and finish the main meal at least 3 hours before bedtime

The correct answer is E. Oesophageal dysmotility and impaired lower oesophageal sphincter function in systemic sclerosis promote reflux, particularly when supine. Raising the head of the bed reduces nocturnal reflux, while completing the main meal at least 3 hours before bedtime reduces reflux from a full stomach. These measures remain appropriate adjuncts even when acid suppression has been optimised. Additional pillows alone may not elevate the torso reliably, and eating immediately before bed worsens reflux. Raising the foot of the bed, acidic drinks and prolonged fluid restriction have no therapeutic rationale. Maximal-dose PPI therapy reduces acidity but does not prevent the physical reflux of gastric contents.

Reference: National Institute for Health and Care Excellence. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management, CG184, recommendation 1.2.2. Updated 2019. https://www.nice.org.uk/guidance/cg184/chapter/Recommendations