Background: Gastro-esophageal reflux disease (GERD) is a well-known complication of scleroderma (SSc). Generally upper gastrointestinal endoscopy and 24-hour esophageal pH monitoring are gold-standard methods for the evaluation of GERD. However, for rheumatologists, more convenient and easy method is necessary for the evaluation of GERD in daily clinical practice for SSc. Kusano developed a questionnaire named FSSG (Frequency Scale for the Symptoms of GERD), which was grossly correlated with endoscopic findings.
Objectives: To evaluate the usefulness of the questionnaire FSSG in patients with SSc.
Methods: There are 12 questions (showed below) and FSSG score of each question is graded from 0 to 4 (Never, Occasionally, Sometimes, Often, Always). FSSG score more than 8 points was regarded as having GERD, which depended on preliminary studies showing a sensitivity of 62%, a specificity of 59% and an accuracy of 60%. The FSSG scoring was done in our 93 SSc patients. Patients are sorted by treatment for GERD at the time when the first FSSG scoring was done. In some patients, the effectiveness of rabeprazol, a new proton pump inhibitor (PPI), is evaluated by the FSSG.
The 12 questions are:
1 Do you get heartburn?
2 Does your stomach get bloated?
3 Does your stomach ever feel heavy after meals?
4 Do you sometimes subconsciously rub your chest with your hand?
5 Do you ever feel sick after meals?
6 Do you get heartburn after meals?
7 Do you have an unusual (e.g. burning) sensation in your throat?
8 Do you feel full while eating meals?
9 Do some things get stuck when you swallow?
10 Do you get bitter liquid (acid) coming up into your throat?
11 Do you burp a lot?
12 Do you get heartburn if you bend over?
Results: Forty-seven SSc patients(51%) were considered to have GERD. Average FSSG score of PPI-group was 13.2, that of H2 blocker group was 9.3, that of other treatment group was 11.6 and that of no treatment group was 7.1 points. Rabeprazole (20 mg/day) ameliorated FSSG score even in some patients who had treated with other PPIs or H2 blockers.

Conclusion: The questionnaire FSSG is a useful tool for detecting GERD in scleroderma patients and evaluating the efficacy of treatment. Rabeprazole is effective for lowering FSSG score.
References: Kusano M, et al.: J Gastroenterol 2004; 39: 888-891