Document resource
Introduction Swallowing impairment due to esophageal involvement is frequently diagnosed in patients with systemic sclerosis (SSc). We previously showed that proximal swallowing abnormalities may involve up to 50% of patients. Despite such prevalence, the characteristics of self-reported oropharyngeal dysphagia and its impact are poorly understood. In this study, we aim at assessing the prevalence and features of self-reported oropharyngeal dysphagia (OD) and evaluate its impact on QoL in SSc patients.Material and Methods 60 consecutive SSc patients were recruited by the Scleroderma Unit of Marche University Hospital, Ancona, Italy. Every participant completed the Italian version of three questionnaires: the Eating Assessment Tool-10 (EAT-10), the Swallowing Quality of Life Questionnaire (SWAL-QoL) and the Dysphagia Handicap Index (DHI). The total scores of EAT-10, DHI and SWAL-QoL and patients’ clinical characteristics were summarized using descriptive statistics. Statistically significant differences between patients self-reporting dysphagia symptoms (EAT-10 score >3) and non-dysphagic patients were evaluated using non-parametric tests and Chi-squared test as appropriate. Correlations between variables was estimated using the Spearman correlation coefficient.Results Of the 60 SSc patients, 30 (50%) had EAT-10 score >3. Patients with OD were more likely to have esophageal involvement (78% vs 34%, p=0.001), reflux and use of proton pump inhibitors (71% vs 40% and 85% vs 56%, p=0.016 and 0.015, respectively) and self-reported xerostomia (74% vs 43%, p = 0.019). They also had a higher burden of disease activity (mRSS and EUSTAR-AI) and poorer functioning and QoL. The median SWAL-QoL and DHI scores were all significantly lower or higher, respectively, in dysphagic patients. There was a strong correlation between all the sub-scores of the three questionnaires. EAT-10 moderately correlated with GIT2.0-10 (rho 0.75), and with measures of physical functioning (Cochin hand function scale rho 0.63, HAQ rho 0.67) and global assessment (PtGA and PhGA rho 0.54 and 0.45, respectively), but not with SSc disease activity. EAT-10 showed a moderate correlation with SF-36 sub-scales, including limitations due to physical role and pain (rho -0.54 and -0.53, respectively) and limitations due to emotional problems and mental health (rho -0.43 and -0.36, respectively). Significant correlations between DHI and SWAL-QoL sub-scores and CHFS, HAQ, PtGA and PhGA and SF-36 were also observed.Conclusions Proximal dysphagia involves half of SSc patients and is associated with disease burden and poor QoL. EAT-10, DHI, SWAL-QoL are valid and reliable instruments to detect self-reported OD in SSc patients.