Background Apart from skin involvement, the gastrointestinal (GI) system is the second most commonly involved organ in systemic sclerosis (SSc), affecting over 80% of the patients. Although rarely being a direct cause of death, it is associated to a high morbidity and to a significant impairment in health-related quality of life (HRQoL). Few data are published considering the influence of GI manifestations in the quality of life of SSc patients.
Objectives The purpose of this study is to characterize the impact of GI involvement in HRQoL in SSc, and to compare it with that in patients with inflammatory bowel disease (IBD).
Methods 29 consecutive SSc patients with GI involvement were selected from a cohort of 44 SSc patients, followed in a single referral centre and classified according to 2013 ACR/EULAR criteria. Comparative analysis was made with 24 consecutive patients with IBD without arthritis (14 Crohn's disease; 10 - ulcerative colitis). Health Assessment Questionnaire (HAQ-DI) and Short Form 36 (SF36), physical component summary (PCS) and mental component summary (MCS) scales, were used to assess HRQoL in both groups. The UCLA Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0 (UCLA SCTG GIT 2.0) was performed in SSc patients to assess the severity of GI involvement. Clinical data were obtained by medical records review. T-test and Fisher's exact test were used to compare binary variables. Pearson's correlation was used for continuous variables.
Results The most common GI segments involved in SSc patients were the esophagus in 90%, the stomach in 60% and the bowel in 48%, while the anorectum was involved in a smaller percentage (10.3%). The mean UCLA SCTG GIT 2.0 score was 0.64±0.51, compatible with a moderate severity, with higher scores obtained for reflux, distention and emotional wellbeing. The mean HAQ-DI score was 1.13±0.57 (0-best health), and the mean PCS and MCS scores were 35.2±9.4 and 35.3±11.4 (100-best health), respectively. These scores were significantly worse than in SSc patients without GI involvement (HAQ-DI - p=0.001; PCS - p=0.04 and MCS - p=0.005). There was a significant correlation between higher UCLA SCTG GIT 2.0 scores and worse quality of life evaluated by HAQ-DI (r=0.42, p=0.03), but the same correlation was not found for the SF36 components. Comparing with IBD patients, SSc patients with GI involvement had worse life quality, with statistical significantly higher HAQ-DI (p<0.001) and lower PCS (p<0.001) and MCS (p=0.01) scores.
Conclusions GI involvement in SSc significantly impaired patient's quality of life. The impact of GI involvement in HRQoL of SSc patients was more severe than in IBD patients. Although physical components were relevant, with esophagus being most frequently involved, mental components associated with GI involvement significantly compromised HRQoL in SSc. Therefore, the assessment of SSc patients using clinical severity measure tools, similar to UCLA SCTG GIT 2.0 score, is crucial for a better characterization of the disease and to an optimized clinical approach.
Disclosure of Interest None declared
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