Slow Colonic Transit in Systemic Sclerosis: An Objective Assessment of Risk Factors and Clinical Phenotype

Abstract

Objective. Up to 50% of patients with systemic sclerosis (SSc) experience slow colonic transit, which may be associated with severe outcomes. Our objective, therefore, was to identify specific clinical features associated with slow colonic transit in SSc.Methods. SSc patients with gastrointestinal symptoms were prospectively enrolled and completed a scintigraphy-based whole gut transit study. Clinical features were compared between patients with and without slow colonic transit in univariate and multivariable logistic regression analyses.Results. Forty-eight of 100 patients (48%) in our cohort had slow colonic transit. In the univariate analyses, slow colonic transit was positively associated with female sex (odds ratio [OR] 12.61 [95% confidence interval (95% CI) 1.56-101.90]), telangiectasia (OR 4.00 [95% CI 1.32-12.10]), anticentromere antibodies (OR 3.25 [95% CI 1.25-8.44]), prior or current smoking (OR 2.56 [95% CI 1.06-6.21]), and a Medsger gastrointestinal severity score of ≥3 (OR 3.94 [95% CI 1.16-13.36]). Patients were less likely to have significant restriction on pulmonary function tests (OR 0.23 [95% CI 0.09-0.63]). In our multivariable model, the association between slow colonic transit and telangiectasia ) and less restrictive lung disease on pulmonary function tests (OR 0.28 [95% CI 0.09-0.86]) remained statistically significant, though a trend with smoking remained ). Interestingly, there were no significant associations between slow colonic transit and delayed transit in other regions of the gastrointestinal tract.Conclusion. Distinct clinical features are associated with slow colonic transit in SSc. Such features may provide insight in risk stratification and the study of disease mechanism in more homogeneous subgroups.

Antivinculin Antibodies in Systemic Sclerosis: Associations With Slow Gastric Transit and Extraintestinal Clinical Phenotype

“…This prevalence is similar to the findings of a study by Suliman et al in which antivinculin antibodies were identified in 37% of a SSc cohort enriched for GI disease and in 32% of an SSc cohort enriched for vascular disease (15). While our cohort had slightly more severe GI disease compared to patients who did not complete the WGT study (25), we also included patients who were minimally symptomatic, which could explain why the prevalence of antivinculin antibodies in our cohort was slightly lower.…”

Gastrointestinal involvement in systemic sclerosis: pathogenesis, assessment and treatment

“…Dysfunction of neuropathic and myopathic processes contributes to delayed colonic transit leading to symptoms such as distension or fullness after meals, abdominal pain and straining during bowel movements [69]. Risk factors for delayed colonic transit include female sex, presence of telangiectasia, presence of anticentromere antibodies, past history of smoking and a Medsger gastrointestinal severity score of at least 3 [9 ▪ ]. After constipation, diarrhoea is the second most common clinical feature of large intestine involvement in SSc.…”

“…As significant clinical heterogeneity exists in SSc-GI disease [6,9 ▪ ,10,11], the underlying pathophysiology is complex and may vary across patient subsets. The classic hypothesis proposed by Sjogren nearly 3 decades ago suggested that SSc-GI disease arises from a three-step sequential process, which includes neural dysfunction, smooth muscle atrophy and fibrosis [12].…”