AB0509 Gastrointestinal involvement in systemic sclerosis patients

Abstract

Background Gastrointestinal involvement in systemic sclerosis (SS) is frequent (70-90% of the patients), different (it affected the whole digestive system) and persistent, contributing to the alteration of quality of life in the patients. In order to prevent severe complications of this manifestation it is necessary to diagnose early and initiate the adequate treatment. Objectives Studying the variants of presentation of gastrointestinal involvement in systemic sclerosis patients and finding their dependence on the clinical forms of the disease. Methods The study comprised 105 patients with SS, out of which only 6 were male. The mean age of the study group was 44,2 years. The mean disease duration – 14,3 years. Out of them, 78 (74,3%) patients displayed a limited form of disease and 27 (13,3%) patients had diffuse injury. We have used ARA criteria (1980) as diagnostic tools. The patients were followed up during 5 years (2007-2012). They were comprehensively examined clinically and paraclinically, inclusively fibroesophagogastroduodenoscopia (FEGDS), X-ray examination with barium contrast of esophagus and bowel, microbiological examination of the stool. Results The frequency of gastrointestinal involvement in the studied patients was 84,8% (89 persons). According to the patients’ complaints they were devised as following: the dry mouth-31,5%, microstomia-23,6%, heavy teeth problems-19,1%, disfagia-71,9%, heartburn-53,9%, early empting of stomach-36%, nausea-16,9%, distention/bloating-50,6%, abdominal pain-50,6%, recurrent diarrhea-25,8%, constipation-46,1% (41 patients), anal sphincter incontinence-4,5%, (4 patients), significant weight loss-33,7% (30 patients). According to detected disorders on imagistic examination: esophageal hypomotility, observed on X-ray examination with barium contrast-66,3 % (59 patients), esophageal dilatation detected on chest computer tomography-29,2 % (26 patients), esophagitis detected on FEGDS -15,7% (14 patients), the presence of gastric antral vascular ectasia-4,5% (4 patients), bowel hypo motility was observed on X-ray examination with barium contrast-32,6% (29 patients), malabsorption syndrome-3,4% (3 patients), primary biliary cirrhosis-1,1% (1patient). During the observation died 4 patients (4,5%), among them 1 (1,1%) died of severe malabsorbtion. Analyzing the dependence variants of digestive involvement on clinical form of the disease we observed that in diffuse form is present diarrhea (77,8% versus 2,6%, p<0,01), malabsorption syndrome (11,1% versus 0%, p<0,01), weight loss (70,4% versus 14,1%, p<0,01), but in limited form – disfagia (66,7% versus 44,4%, p<0,05), heartburn (50% versus 33,3%, p<0,05), constipation (49,7% versus 11,1%, p<0,01), anal sphincter incontinence (5,1% versus 0%, p<0,05). Conclusions Digestive involvement in patients with systemic sclerosis is frequent, diverse and complex. Patients with diffuse form frequently develop diarrhea, malabsorbtion syndrome and, weight loss, but those with limited form – disphagia, heartburn, constipation and anal sph...