Determining the Risk Factors and Clinical Features Associated With Severe Gastrointestinal Dysmotility in Systemic Sclerosis

Paik, Julie J; Wigley, Fredrick M.; Hummers, Laura K.

doi:10.1002/acr.23479

Cited by 35 publications

(30 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Gastrointestinal symptoms were frequent in our study population (82.5%) irrespective of disease phenotype and comparable to other studies [4,27]. Certain foods might either perpetuate or facilitate the appearance of diseaserelated digestive manifestations in systemic sclerosis [9].…”

Section: Resultssupporting

confidence: 91%

“…Disease pathogenic mechanisms involve immune, vascular and neural changes as well as a widespread fibrosis of the skin and visceral organs [1][2][3]. Food-related behavior (including the ability to procure and process food) is challenged by the severe hand disability resulting from extended skin fibrosis and joint contractures in scleroderma [4].…”

mentioning

confidence: 99%

“…The progressive deposition of extracellular matrix proteins causes a substantial loss of function affecting organs such as the skin, lungs, and kidneys. Disease-related changes involve the gastrointestinal (GI) tract in its entirety in up to 90% of cases [4,5]. SSc patients develop microstomia, xerostomia, edentation, dysphagia, and acid reflux, as well as gastroparesis and consecutive early satiety [6][7][8].…”

mentioning

confidence: 99%

“…As yet, studies used scoring systems such as the Malnutrition Universal Screening Tool (MUST), Mini Nutritional Assessment (MNA), University of California Los Angeles Scleroderma Clinical Trials Consortium Gastrointestinal Tract Questionnaire (GIT 2.0), and Subjective Global Assessment (SGA) in order to estimate gastrointestinal involvement and risk of malnutrition in patients with scleroderma [4,[21][22][23].…”

mentioning

confidence: 99%

See 3 more Smart Citations

Nutritional Decline in Scleroderma Patients Data from a single Romanian center

Burlui¹,

Graur²,

Constantinescu³

et al. 2018

Rev. Chim.

View full text Add to dashboard Cite

Malnutrition has been known to provide poor survival outcomes in systemic sclerosis (SSc). We recruited a series of 40 consecutive SSc patients, 22 (55%) with limited cutaneous involvement and 18 (45%) with the diffuse form of disease. The study group was evaluated using the modified Rodnan skin score (mRSS), anthropometric measurements, the EPIC-Norfolk Food Frequency Questionnaire, the Malnutrition Universal Screening Tool (MUST) as well as circulating albumin and vitamin D. MUST scores were correlated with mRSS and serum albumin (R=0.40, p=0.010, and R=-0.46, p=0.003, respectively). Serum vitamin D values were inversely related to mRSS (R=-0.35, p=0.026). We recorded a greater number of daily gastrointestinal symptoms associated with diets rich in sodium, fat, sugars and snacks, carotene, and �-tocopherol equivalents (vitamin E) in our study population. Scleroderma patients might benefit from nutritional counseling in order to follow a diet tailored to their specific needs.

show abstract

Section: Resultssupporting

confidence: 91%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Nutritional Decline in Scleroderma Patients Data from a single Romanian center

Burlui¹,

Graur²,

Constantinescu³

et al. 2018

Rev. Chim.

View full text Add to dashboard Cite

show abstract

“…Estimated right ventricular systolic pressure was measured by echocardiogram and obtained as part of routine clinical screening for pulmonary hypertension; the maximum value at any visit was used for analysis. Sicca symptoms were defined as previously described . Renal crisis was confirmed by renal biopsy in the context of an acute symptomatic increase in blood pressure.…”

Section: Methodsmentioning

confidence: 99%

Anti–RNPC‐3 (U11/U12) Antibodies in Systemic Sclerosis in Patients With Moderate‐to‐Severe Gastrointestinal Dysmotility

McMahan

Domsic

Zhu

et al. 2019

Arthritis Care & Research

Self Cite

View full text Add to dashboard Cite

Objective. To examine the association of anti-RNPC-3 antibodies in patients with systemic sclerosis (scleroderma or SSc) with selected gastrointestinal (GI) tract complications.Methods. Sera from patients with SSc with or without severe GI dysfunction (total parenteral nutrition dependence) from the Johns Hopkins Scleroderma Center were screened for anti-RNPC-3 antibodies. We then examined anti-RNPC-3-positive cases and negative SSc controls from the University of Pittsburgh and the University of Pittsburgh Medical Center (UPMC) scleroderma cohort to confirm our findings and to examine whether specific GI features were associated with anti-RNPC-3 antibodies.Results. In the discovery cohort, patients with SSc with severe GI dysfunction (n = 37) and without GI dysfunction (n = 38) were screened for anti-RNPC-3 antibodies. The former were more likely to have anti-RNPC-3 antibodies (14% versus 3%; P = 0.11). In the Pittsburgh cohort, moderate-to-severe GI dysfunction (Medsger GI score ≥2) was present in 36% of anti-RNPC-3-positive patients versus 15% of anti-RNPC-3-negative patients (P ≤ 0.01). Anti-RNPC-3-positive patients were more likely to be male (31% versus 15%; P = 0.04), African American (18% versus 6%; P = 0.02), have esophageal dysmotility (93% versus 62%; P < 0.01), and interstitial lung disease (ILD) (77% versus 35%; P < 0.01). After adjusting for relevant covariates and potential confounders, moderate-to-severe GI disease was associated with anti-RNPC-3 antibodies (odds ratio [OR] 3.8 [95% confidence interval (95% CI) 1.0-14.3]), and ILD trended toward significance (OR 2.8 [95% CI 1.0-8.2]).Conclusion. Patients with SSc and anti-RNPC-3 antibodies are more likely to be male and African American and to have moderate-to-severe GI disease and ILD. Further studies on larger patient cohorts may be helpful in further defining subsets of patients with SSc at risk for severe GI involvement.

show abstract

Relationship Between Gastrointestinal Transit, Medsger Gastrointestinal Severity, and University of California–Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0 Symptoms in Patients With Systemic Sclerosis

Tucker

Perin

Volkmann

et al. 2022

Arthritis Care & Research

Self Cite

View full text Add to dashboard Cite

Objective. Systemic sclerosis (SSc)-associated gastrointestinal (GI) complications are attributed to a variety of factors, including diet, microbiota dysbiosis, or GI transit abnormalities. Our objective was to examine the contribution of abnormal GI transit to SSc Medsger GI severity scores and/or University of California Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract (UCLA GIT) 2.0 symptoms.Methods. Patients with SSc and GI symptoms (n = 71) and healthy controls (n = 18) underwent whole gut transit (WGT) scintigraphy to assess transit from the esophagus to the colon. The presence of delayed transit and percent emptying in each GI region were measured. We compared the WGT measurements between categories of the Medsger GI severity score (0-4) and across UCLA GIT 2.0 domains and total score (0-3).Results. A total of 88% of patients had >1 abnormal region of the gut on WGT scintigraphy. All patients requiring total parenteral nutrition had delayed small bowel transit, compared to only approximately 11% of patients in other Medsger GI severity groups (P ≤ 0.01). Severe colonic transit delays were more likely in patients with Medsger GI scores of 3 (pseudo-obstruction and/or malabsorption) compared to other Medsger GI groups (P = 0.02). Seventypercent of these patients had ≤30% colonic emptying at 72 hours. Modest associations were noted between gastroesophageal reflux disease symptoms and delayed esophageal (r = -0.31, P = 0.05) and gastric emptying (r = -0.32, P = 0.05).Conclusion. These data are important in providing evidence that SSc bowel disease affects transit of GI content and that delay in transit accounts in part for both bowel symptoms and Medsger GI severity. Prospective studies examining the benefit of early therapeutic intervention targeting GI transit abnormalities in patients at high risk for severe GI complications are needed.

show abstract

Determining the Risk Factors and Clinical Features Associated With Severe Gastrointestinal Dysmotility in Systemic Sclerosis

Abstract: Distinct clinical features are present in SSc patients who are at risk of developing severe GI dysmotility. This finding is not only important clinically but also suggests that a unique pathologic process is at work in these patients.

Cited by 35 publications

References 18 publications

Nutritional Decline in Scleroderma Patients Data from a single Romanian center

Nutritional Decline in Scleroderma Patients Data from a single Romanian center

Anti–RNPC‐3 (U11/U12) Antibodies in Systemic Sclerosis in Patients With Moderate‐to‐Severe Gastrointestinal Dysmotility

Relationship Between Gastrointestinal Transit, Medsger Gastrointestinal Severity, and University of California–Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0 Symptoms in Patients With Systemic Sclerosis

Contact Info

Product

Resources

About