Document resource
Introduction Gastrointestinal involvement (GI) occurs in the majority (>90%) of patients with systemic sclerosis (SSc) and is associated with significant morbidity and disease-related mortality. Our aim was to describe our experience of SSc-GI involvement, including benchmarking the burden of disease and identifying associates of GI involvement.Material and Methods A retrospective cohort study of patients attending Salford Royal Hospital (a UK national referral centre for SSc). Consecutive patients were eligible for inclusion (between 1st January 2024 to 31st December 2024). Relevant patient- and disease-related demographic, rheumatological and GI data were obtained from the electronic patient records. We developed a novel practical GI symptom burden score to quantify the burden of GI disease: 0 (‘no GI symptoms’), 1 (‘effectively managed GI symptoms’), or 2 (‘unmanaged GI symptoms’). Descriptive statistics were used to describe the data, and the chi-squared test was used to assess for associations with GI symptoms.Results 149 patients were included in our analysis, 86% female. Most (71%) had limited cutaneous SSc with broad-ranging involvement (interstitial lung disease (ILD): 31%, pulmonary artery hypertension (PAH): 8%, digital ulcer history (DU): 52%, myositis: 13%). The median (SD) Raynaud’s phenomenon and SSc-disease duration were 19.3 (13.5) and 11.1 (43.0) years, respectively.Over half (61%) of patients had evidence of current GI symptoms (score 1 or 2), of whom (43%) had unmanaged symptoms (score 2). The most common symptoms (recorded in the most recent clinic letter) were reflux (32%) and dysphagia (28%). Proton pump inhibitor (PPI) use was high (81%).Both anticentromere (n=57) and anti-Scl70 (n=25) antibodies were associated with GI symptoms (both P<0.001); however, no association was observed with anti-RNA polymerase III antibody (n=20), or diffuse or limited cutaneous subset. GI involvement increased in line with the timeline of the disease, 66% those with a disease duration over the median scored ‘1’ or ‘2’. Almost two-thirds of individuals with history of DU (61%), and half of those with PAH (50%) or ILD (50%) had GI symptoms (score ‘1’ or ‘2’). Over half (63%) of those with myositis overlap showed GI involvement.Conclusions GI involvement is common in patients with SSc and often refractory to treatment. PPI use in our cohort was high. We have identified several clinical and serological factors associated with GI involvement, and is frequent in patients with myositis overlap.