Pos1312 prevalence of gastrointestinal symptoms and objective gastrointestinal dysmotility in patients with systemic sclerosis

Background After the skin, the gastrointestinal tract is the most frequently affected system in systemic sclerosis (SSc). The pathophysiology of gastrointestinal symptoms is mostly secondary to gastrointestinal dysmotility. Due to the increase survival in patients with systemic sclerosis, digestive manifestations are becoming more relevant in the comprehensive management of the disease. Objectives To assess the prevalence of gastrointestinal symptoms, the presence of gastric and intestinal dysmotility in objective testing and to examine associations between gastrointestinal involvement and other systemic sclerosis features. Methods A cross-sectional study was conducted in the cohort of active SSc patients in a tertiary center. Patients who fulfilled LeRoy or ACR/EULAR 2013 classification criteria were contacted by telephone and asked to complete standardized questionnaires: UCLA-GIT 2.0, IBS-SSS (IBS symptom severity score), a gastrointestinal symptoms questionnaire and the SF-36 (quality of life). Questionnaire terminology was altered to replace references to ‘IBS’ with ‘GI symptoms’. Demographic, clinical-immunological data and results of complementary motility tests were collected from the medical records. Gastrointestinal motility was assessed by gastric emptying scintigraphy, small intestinal manometry and/or abdominal CT scan. Results A total of 183 SSc patients participated in the study with a mean age ± standard deviation (SD) of 59±12 years, 103 (55%) patients had limited cutaneous SSc (lcSSc) subset, 43 (24%) diffuse cutaneous SSc (dcSSc), and 37 (21%) sine sclerosis SSc (ssSSc). 139 (77%) patients reported having at least one frequent digestive symptom (>1 day/week). The prevalence of digestive symptoms correlated negatively with overall quality of life measured by SF-36 (r= -0.503 p=<0.001). In univariate analysis, female gender (87 vs 73%; p=0.025), onset at an early age (44±7 vs 50±6 years; p=0.037) and a capillary loss pattern (23% vs 7%; p=0.023) were associated with the presence of digestive symptoms. Gastrointestinal motility assessment detected gastroparesis in 18/31 (total 58%; mild n=6, moderate n=5, severe n=7), small bowel abnormal motility patterns in 6/6 (total 100%, neuropathic n=1, myopathic n=5) and small bowel dilated loops in 6/65 patients (total 9%, CT scan). Among the patients studied by gastric emptying scintigraphy, gastric retention at 4 hours had a moderate positive correlation with IBS-SSS and UCLA GIT 2.0 scores (r=0.433 and r=407, p=<0,01 respectively). Figure 1. Moderate-severe gastrointestinal involvement (21 patients, 11%) was associated with older age at SSc onset (45 ± 9 vs 36 ± 14 years; p=0.012), dcSSc (57% vs 18%; p=0.001), myositis (24% vs 3%, p=0.011), tendon friction rubs (29% vs 3%, p=0.003) erosive esophagitis (10% vs 57%, p=0.001) despite proton bomb inhibitor treatment. Patients with moderate-severe gastrointestinal involvement had a worse (higher) UCLA GIT 2.0 score (1.05 ± 0.63 vs 0.62 ± 0.51; p=0.043) mainly due to reflux (1.07 ± 0.63 vs 0.58 ± 0.61; p=0.001) and bloating (1.85 ± 0.78 vs 1.23 ± 0.94; p=0.001) and greater severity of abdominal symptoms (IBS-SSS score, 185 ± 91 vs 146 ± 113; p=0.032). All patients (n=6) with chronic intestinal pseudo-obstruction presented dcSSc subset. Conclusion Patients with SSc have a high prevalence of digestive symptoms and objective gastrointestinal dysmotility that negatively impact their quality of life. Gastrointestinal dysmotility seems to worsen reflux disease. The dcSSc subset is associated with more severe gastrointestinal involvement. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests None Declared.