AB0710 STUDY OF THE GASTROINTESTINAL INVOLVEMENT IN PATIENTS WITH SYSTEMIC SCLEROSIS

Abstract

BackgroundSystemic Sclerosis (SSc) is a systemic autoimmune disease in which the gastrointestinal (GI) manifestation is one of the most frequent complications (90%), being esophagus and anorectal the most affected regions. The set of GI symptoms poses a diagnostic and therapeutic challenge, and the “Patient Reported Outcomes” (PRO) are good tools to address them. The UCLA GIT 2.0 validated questionnaire can be used as an instrument to measure the presence and severity of these symptoms, allowing screening, and improving subsequent management.ObjectivesTo describe gastrointestinal (GI) involvement in patients with SSc.MethodsDescriptive cross-sectional study conducted in a cohort of patients with SSc in a tertiary hospital. Sociodemographic, clinical, complementary tests and treatment variables were collected. Patients with established GI involvement needed to have urdergone some previous diagnostic test. The UCLA GIT 2.0 questionnaire was applied to all included patients, considering the presence of mild symptoms with a score of 0-0.49, moderate 0.49-1, and severe 1-3.Results88 patients (90% women) were recruited, with a mean age of 61.3 years. They presented the subtypes of limited and diffuse SSc in 63.3% and 13.6%, respectively. The most frequent antibodies were anticentromere (ACA) in 52.3% of the patients, anti-Ro52 in 20.5% and anti-topoisomerase I in 14.8%. The most frequent manifestations were Raynaud’s phenomenon in 98.8% of the patients followed by GI in 37.5% (gastro-esophageal reflux in 88.2%), diffuse interstitial lung disease in 18% and pulmonary hypertension in 10.22%. The most used treatment was proton pump inhibitors (PPI) in 47.7% of the patients.Patients with GI involvement presented the limited SSc subtype (72.7%) and ACA (60.6%) as main characteristics. Patients without digestive involvement had similar characteristics, but did not show a greater association with any specific antibody (p=0.321).67% of the total number of patients presented a score greater than 0 in the UCLA GIT 2.0 questionnaire, with the reflux section being the most frequent (52.27%). In relation to the total score, they presented mild, moderate, and severe symptoms in 77.3%, 21.6% and 1.1% of the patients respectively. The rest of the results by categories are summarized in Table 1.Table 1.Gastrointestinal involvement(n= 34)Without gastrointestinal involvement(n= 54)Subtype and antibodies Limited24 (70,58%)32 (59,25%) Diffuse5 (14,70%)7 (12,96%) ACA20 (58,82%)26 (48,14%) ATA5 (14,70%)8 (14,81%)Manifestations and treatment ILD5 (14,70%)11 (20,37%) PAH3 (8,82%)6 (11,11%) PPI31 (91,17%)11 (20,37%)UCLA GIT 2.0 (median) Total score0,300,05 Reflux0,350 Swelling0,620 Stain00 Diarrhea*00 Social functioning00 Emotional well-being0,220 Constipation Ɨ00ILD (intersticial lung disease), PAH (pulmonary arterial hypertension), ACA (anti-centromere), ATA (anti-topoisomerase), PPI (proton pump inhibitors).*In the “diarrhea” subcategory the maximum score is 2.Ɨ In the “constipation” subcategory the maximum score is 2,5.Patients with GI pathology presented higher scores (moderate-severe) compared to those without pathology (p=0.009). In this last group, 34.5% of the patients presented GI symptoms according to the test, observing high scores in the bloating, reflux, and constipation sections in 25.2%, 16.6% and 14.8% of the patients respectively.ConclusionGI involvement tends to be one of the most frequent manifestations in our cohort and occurs more frequently in patients with limited skin involvement and ACA +. Patients with established GI pathology had higher scores on the UCLA test. The questionnaire may be useful in detecting undiagnosed patients, but more studies are necessary to establish this possible correlation.References[1]Jose Luis Tandaipan, Ivan Castellví. Systemic sclerosis and gastrointestinal involvement. Rev Colomb Reumatol. 2020;27(S1):44-54.[2]Dinesh Khanna, et al. Measuring Response in the Gastrointestinal Tract in systemic sclerosis. Curr Opin Rheumatol. 2013;25(6).Disclosure of InterestsNone declared