1
|
Hisada S, Takeuchi S, Tozawa T, Yamada Y, Ito Y, Kodera M. Cross-sectional study using the University of California, Los Angeles, Scleroderma Clinical Trials Consortium Gastrointestinal Tract Instrument 2.0 (UCLA SCTC GIT 2.0) for gastrointestinal disorders of systemic sclerosis. J Dermatol 2024. [PMID: 38963343 DOI: 10.1111/1346-8138.17327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/07/2024] [Accepted: 05/26/2024] [Indexed: 07/05/2024]
Abstract
This study aimed to identify severe gastrointestinal ailments in patients with systemic sclerosis (SSc), investigate the role of antibodies in gastrointestinal disorders, and explore the relationship between limited cutaneous SSc (lcSSc) and diffuse cutaneous SSc (dcSSc) in terms of gastrointestinal involvement and its association with skin stiffness. We used the University of California, Los Angeles, Scleroderma Clinical Trials Consortium Gastrointestinal Tract Instrument 2.0 (UCLA SCTC GIT 2.0) questionnaire to assess gastrointestinal disturbances in 100 patients with SSc. Gastrointestinal impairment was categorized into three levels: absence of or minor symptoms, moderate symptoms, and severe symptoms, as indicated by the total gastrointestinal tract (GIT) score. Comparing 27 patients with dcSSc and 73 patients with lcSSc, severe gastrointestinal disturbances were found in 7.4% of patients with dcSSc and 4.1% of patients with lcSSc. A total of 18.0% of anticentromere antibody (ACA)-positive patients exhibited moderate to severe symptoms, while 9.1% of antitopoisomerase 1 antibody-positive patients displayed similar symptoms. The average disease duration in patients with severe symptoms was 15.0 years, in those with moderate symptoms was 10.3 years, and in those who were symptom-free or mildly affected was 8.5 years. Among 16 patients with moderate to severe gastrointestinal disorders, a positive correlation was observed between the modified Rodnan skin thickness score (mRSS) and total GIT score. In addition, a positive correlation was identified between fecal incontinence and mRSS, with weaker correlations for reflux and bloating symptoms. Patients with gastrointestinal disorders showed a tendency to worsen over time, particularly in ACA-positive patients with dcSSc. Furthermore, a correlation was observed between mRSS and fecal incontinence, reflux, and abdominal bloating in patients with moderate to severe gastrointestinal disturbances.
Collapse
Affiliation(s)
- Satoko Hisada
- Division of Dermatology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Saki Takeuchi
- Division of Dermatology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Takahisa Tozawa
- Division of Dermatology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Yoshihiro Yamada
- Division of Dermatology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Yumi Ito
- Division of Dermatology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Masanari Kodera
- Division of Dermatology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| |
Collapse
|
2
|
Yakut T, Cinar C, Karakurt S, Direskeneli H, Yalcinkaya Y, Peker Y. Esophagus Dilation and Quality of Life in Adults with Scleroderma and Concomitant Obstructive Sleep Apnea. J Clin Med 2024; 13:1884. [PMID: 38610649 PMCID: PMC11012771 DOI: 10.3390/jcm13071884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Systemic sclerosis (SSc) is a rare systemic disease, which often affects the esophagus, leading to dilation and complications such as dysphagia and reflux. Obstructive sleep apnea (OSA) is a chronic condition with recurrent episodes of upper airway collapsibility and is known to impair quality of life (QoL). The primary aim of this study was to investigate the occurrence of esophagus dilation in patients with SSc and concomitant OSA and, further, to address the impact of these conditions on QoL. (2) Methods: In this cross-sectional cohort study, 62 consecutive patients with SSc underwent chest computer tomography (CT) and home sleep apnea testing. The OSA diagnosis was based on AHI ≥ 15 events/h. The QoL was quantified using the short-form (SF)-36 questionnaire. The patients were dichotomized as high- vs. low-esophageal-diameter groups, based on the median cut-off values. (3) Results: The mean age was 48 ± 11 years; 58 (93.5%) were female; the mean BMI was 26.7 ± 5.0 kg/m2. The median esophageal diameter was 17.47 mm. A larger esophageal diameter was more frequently associated with the diffuse cutaneous subtype of SSc (p = 0.002) and significantly higher Warrick scores (p < 0.001), indicating more severe pulmonary fibrosis. There was a significant linear correlation between the Warrick score and the esophageal diameter (standardized β coefficient 0.544 [%95 confidence interval 0.250-0.609]; p < 0.001). In the subgroup analysis, the patients with both OSA and enlarged esophageal diameter experienced a significant decline in QoL, particularly in the domains of physical functioning, role physical, general health, role emotional, and vitality. (4) Conclusions: While OSA was not directly associated with enlarged esophageal diameter in patients with SSc, those with both OSA and enlarged esophageal diameter exhibited a significant decline in QoL. These findings suggest that the presence of OSA may exacerbate the adverse effects of esophageal dilation on QoL in SSc patients. Our results underline the importance of considering both gastrointestinal and sleep-related aspects in SSc management to enhance patient QoL.
Collapse
Affiliation(s)
- Tugce Yakut
- Department of Pulmonary Medicine, School of Medicine, Koc University, Istanbul 34010, Turkey;
| | - Caner Cinar
- Department of Pulmonary Medicine, School of Medicine, Marmara University, Istanbul 34722, Turkey; (C.C.); (S.K.)
| | - Sait Karakurt
- Department of Pulmonary Medicine, School of Medicine, Marmara University, Istanbul 34722, Turkey; (C.C.); (S.K.)
| | - Haner Direskeneli
- Department of Rheumatology, School of Medicine, Marmara University, Istanbul 34722, Turkey;
| | - Yasemin Yalcinkaya
- Department of Rheumatology, School of Medicine, Istanbul University, Istanbul 34116, Turkey;
| | - Yüksel Peker
- Department of Pulmonary Medicine, School of Medicine, Koc University, Istanbul 34010, Turkey;
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
- Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, 22185 Lund, Sweden
- Division of Pulmonary, Allergy, and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| |
Collapse
|
3
|
Bento da Silva A, Lourenço MH, Cunha-Branco J, Gonçalves MJ. Particularly severe form of refractory gastrointestinal involvement in systemic sclerosis. BMJ Case Rep 2023; 16:e254537. [PMID: 37015763 PMCID: PMC10083804 DOI: 10.1136/bcr-2022-254537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
A woman with systemic sclerosis presents with a severe and rapidly progressive form of gastrointestinal involvement, mainly marked by recurrent refractory episodes of pseudo-obstruction, culminating in severe malnutrition and dependence of parenteral nutrition. The impact on her quality of life was extremely significant. As a last resort, she started intravenous immunoglobulin with progressive improvement of her symptoms, allowing for the reinstitution of oral diet and removal of parenteral nutrition. After more than 1 year, she maintains clinical stability. Systemic sclerosis has a heterogeneous phenotype, but gastrointestinal involvement is one of the most frequent. Severe manifestations are rare, but can lead to severe malnutrition and are associated with high morbidity and mortality rates. Their management is challenging, as the available treatments are still very limited. A better understanding of its pathophysiology, which seems to be unique, is essential to provide more effective treatments and improving quality of life.
Collapse
Affiliation(s)
- Ana Bento da Silva
- Rheumatology, Centro Hospitalar de Lisboa Ocidental - Hospital de Egas Moniz, Lisbon, Portugal
- Rheumatology, Comprehensive Health Research Center, NOVA Medical School, Lisbon, Portugal
| | - Maria Helena Lourenço
- Rheumatology, Centro Hospitalar de Lisboa Ocidental - Hospital de Egas Moniz, Lisbon, Portugal
- Rheumatology, Comprehensive Health Research Center, NOVA Medical School, Lisbon, Portugal
- Faculdade de Ciências Médicas, NOVA Medical School, Lisbon, Portugal
| | - Jaime Cunha-Branco
- Rheumatology, Centro Hospitalar de Lisboa Ocidental - Hospital de Egas Moniz, Lisbon, Portugal
- Faculdade de Ciências Médicas, NOVA Medical School, Lisbon, Portugal
| | - Maria João Gonçalves
- Rheumatology, Centro Hospitalar de Lisboa Ocidental - Hospital de Egas Moniz, Lisbon, Portugal
- Rheumatology, Comprehensive Health Research Center, NOVA Medical School, Lisbon, Portugal
- Escola Superior de Tecnologia da Saúde de Lisboa, Lisbon, Portugal
| |
Collapse
|
4
|
Lemos MPC, Zucoloto TG, Oliveira MC, de Oliveira GLV. Dysbiosis and Gut Microbiota Modulation in Systemic Sclerosis. J Clin Rheumatol 2022; 28:e568-e573. [PMID: 34030162 DOI: 10.1097/rhu.0000000000001748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Gastrointestinal (GI) involvement is an early manifestation in systemic sclerosis (SSc), affecting more than 90% of patients, and severe GI disease is a marker of poor prognosis and mortality. Recent studies have hypothesized that alterations of the intestinal microbiota, known as dysbiosis, may represent 1 of the possible environmental factors influencing SSc disease status. In addition, specific microorganisms may be associated with SSc pathogenesis, progression, and GI manifestations. Therapeutic approaches aiming to modulate the intestinal microbiota have emerged, as alternatives to treat GI symptoms, and dietary interventions, probiotic administration, and fecal microbiota transplantation are potential therapies for SSc patients. However, given the complexity and variability of pathogenesis and clinical manifestations in SSc, these therapies need to be combined with additional interventions that target other disease components. Here, we summarize studies addressing intestinal dysbiosis in SSc and discuss the potential of microbiota modulators to treat SSc-related GI disorders.
Collapse
|
5
|
Gokcen N. PELVIC FLOOR MUSCLE EXERCISE AND PHYSICAL THERAPY MAY IMPROVE SYSTEMIC SCLEROSIS-ASSOCIATED FECAL INCONTINENCE. CENTRAL ASIAN JOURNAL OF MEDICAL HYPOTHESES AND ETHICS 2021. [DOI: 10.47316/cajmhe.2021.2.2.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Gastrointestinal involvement in systemic sclerosis (SSc) is observed in up to 90% of patients. Resolution of some of these gastrointestinal complications is challenging without the support of physical therapy and rehabilitation. One of these complications, SSc-associated fecal incontinence, which can be devastating for those affected, is seen in up to 39%. Studies focusing on fecal incontinence and its treatment are scarce. The hypothesis presented herein suggests that pelvic floor muscle exercise, biofeedback therapy, and neuromodulation methods might be effective and safe treatment strategies for patients affected by this debilitating complication.
Collapse
|
6
|
Zampatti N, Garaiman A, Jordan S, Dobrota R, Becker MO, Maurer B, Distler O, Mihai C. Performance of the UCLA Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.0 instrument as a clinical decision aid in the routine clinical care of patients with systemic sclerosis. Arthritis Res Ther 2021; 23:125. [PMID: 33888149 PMCID: PMC8061014 DOI: 10.1186/s13075-021-02506-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The University of California Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract Instrument 2.0 (UCLA GIT 2.0) is validated to capture gastrointestinal (GI) tract morbidity in patients with systemic sclerosis (SSc). The aims of this study were to determine in a large SSc cohort if the UCLA GIT 2.0 is able to discriminate patients for whom a rheumatologist with experience in SSc would recommend an esophago-gastro-duodenoscopy (EGD), and if it could identify patients with endoscopically proven esophagitis or with any pathologic finding on EGD. METHODS We selected patients fulfilling the ACR/EULAR 2013 criteria for SSc from our EUSTAR center having completed at least once the UCLA GIT 2.0 questionnaire, and we collected data on gastrointestinal symptoms and EGD from their medical charts. We analyzed by general linear mixed effect models several parameters, including UCLA GIT 2.0, considered as potentially associated with the indication of EGD, as well as with endoscopic esophagitis and any pathologic finding on EGD. RESULTS We identified 346 patients (82.7% female, median age 63 years, median disease duration 10 years, 23% diffuse cutaneous SSc) satisfying the inclusion criteria, who completed UCLA GIT 2.0 questionnaires at 940 visits. EGD was recommended at 169 visits. In multivariable analysis, UCLA GIT 2.0 and some of its subscales (reflux, distention/bloating, social functioning) were associated with the indication of EGD. In 177 EGD performed in 145 patients, neither the total ULCA GIT 2.0 score nor any of its subscales were associated with endoscopic esophagitis, nor with any pathologic EGD findings. CONCLUSIONS In a real-life setting, the UCLA GIT 2.0 and its reflux subscale were able to discriminate patients with SSc who had an indication for EGD, but did not correlate with findings in EGD. We conclude that, while using the UCLA GIT 2.0 in the routine care of patients with SSc may help the rheumatologist to better understand the burden of GI symptoms in the individual patient, it should not be used as a stand-alone instrument to identify an indication of EGD.
Collapse
Affiliation(s)
- Norina Zampatti
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Alexandru Garaiman
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Suzana Jordan
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Rucsandra Dobrota
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Mike Oliver Becker
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Britta Maurer
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland.,Department of Rheumatology and Immunology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland
| | - Carina Mihai
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Gloriastrasse 25, 8091, Zurich, Switzerland. .,Department of Internal Medicine and Rheumatology, Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| |
Collapse
|
7
|
Hoffmann-Vold AM, Volkmann ER. Gastrointestinal involvement in systemic sclerosis: Effects on morbidity and mortality and new therapeutic approaches. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2021; 6:37-43. [PMID: 35382247 PMCID: PMC8922632 DOI: 10.1177/2397198319891282] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/01/2019] [Indexed: 08/22/2023]
Abstract
The majority of research studies in systemic sclerosis focus largely on addressing skin and cardiopulmonary manifestations. Fewer studies assess the pathogenesis and treatment of gastrointestinal tract involvement in systemic sclerosis, despite the fact that the majority of patients with systemic sclerosis have gastrointestinal manifestations and these manifestations are a leading cause of death in systemic sclerosis. The present review provides a comprehensive update on morbidity and mortality outcomes related to gastrointestinal involvement in systemic sclerosis. This review also describes conventional and emerging approaches to managing gastrointestinal symptoms in systemic sclerosis. Recent developments in systemic sclerosis-gastrointestinal research efforts have revealed promising treatment targets, including specific auto-antibodies and microbiota alterations. This review will conclude with an overview of future research directions that may improve our understanding of systemic sclerosis-gastrointestinal involvement and ultimately help to alleviate suffering from this devastating dimension of systemic sclerosis.
Collapse
Affiliation(s)
- Anna-Maria Hoffmann-Vold
- Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Elizabeth R Volkmann
- Division of Rheumatology, Department of Medicine, University of California-Los Angeles (UCLA), Los Angeles, CA, USA
| |
Collapse
|
8
|
Kaniecki T, Abdi T, McMahan ZH. Clinical Assessment of Gastrointestinal Involvement in Patients with Systemic Sclerosis. ACTA ACUST UNITED AC 2020; 8. [PMID: 34337149 DOI: 10.18103/mra.v8i10.2252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Systemic sclerosis (SSc) has the potential to affect any component of the gastrointestinal (GI) tract. GI involvement in SSc is a leading cause of morbidity and overall decreased quality of life in this patient population, identifying a need for a concise approach to work-up. This literature review aims to present a systematic, anatomical approach and differential diagnosis of GI involvement in SSc for the general internist and rheumatologist. Each component of the luminal GI tract has its own specified section, beginning with a review of a clinical approach to diagnosis that includes a differential for clinicians to consider, followed by a discussion of the literature surrounding objective evaluation of these conditions (i.e. serologic studies, imaging, endoscopy). Additionally there is a focused discussion on an approach to GI bleeding in the patient with SSc.
Collapse
Affiliation(s)
| | - Tsion Abdi
- Johns Hopkins University, Division of Gastroenterology
| | | |
Collapse
|
9
|
Cultural adaptation and validation of the Systemic Sclerosis Quality of Life questionnaire into Arabic language. Clin Rheumatol 2020; 40:1409-1416. [PMID: 32918142 DOI: 10.1007/s10067-020-05373-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/22/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Systemic sclerosis (SSc) is a chronic connective tissue disease affecting all quality of life (QoL) parameters. In addition to clinical assessment, QoL measures should be included in patient assessment. There is no Arabic tool specific for assessing QoL in Arabic SSc patients; therefore, this work was designed to translate the SScQoL questionnaire, culturally adapt and check its reliability and validity. METHOD Based on the principle of translation and cross-cultural adaptation in other language, the SScQoL questionnaire was translated into Arabic. Correlation of SScQoL scores for 50 patients with Short Form Health Survey (SF-36) scores has been tested for convergent validity and discriminate validity evaluated by stratifying clinical parameters of patients and disease subtypes. The intraclass correlation coffee (ICC) was used to assess reliability by interviewing patients twice 14 days apart. RESULTS Correlations were present between SScQoL scores and physical and mental component scores of SF-36 questionnaire. We found strong negative correlation between the physical component of SF-36 and QoL function, QoL emotion, QoL total scores (r = - 0.654**, r = - 0.512**, r = - 0.540**) and moderate negative correlation present between SF-36 mental component and QoL function, QoL emotion, QoL social, and QoL total (r = - 0.314*, r = - 0.486**, r = - 0.357*, r = - 0.433*). Also, significant association (P < 0.05*) between scores of total QoL and visceral involvements (GIT involvement, pericardial effusion, and LVDD) was evident. The Arabic edition of SScQoL has a Cronbach's alpha of 0.78. CONCLUSION The translated Arabic version is a valid and reliable tool to assess Egyptian SSc patients' QoL. Key Points • The SScQoL questionnaire items have a convergent validity with physical and mental component scores of SF-36, and discriminant validity with visceral involvement. • The Arabic edition of SScQoL is reliable with a Cronbach's alpha of 0.78.
Collapse
|
10
|
The Role of Fecal Calprotectin in Patients with Systemic Sclerosis and Small Intestinal Bacterial Overgrowth (SIBO). Diagnostics (Basel) 2020; 10:diagnostics10080587. [PMID: 32823752 PMCID: PMC7459882 DOI: 10.3390/diagnostics10080587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/01/2020] [Accepted: 08/10/2020] [Indexed: 01/13/2023] Open
Abstract
Fecal calprotectin (FC) is a quick, cost-effective, and noninvasive test, which is used to diagnose patients with active inflammatory bowel diseases (IBD). Recent studies suggest the possible predictive role of FC in the diagnosis of small intestinal bacterial overgrowth (SIBO) in patients with systemic sclerosis (SSc). This study aimed to assess the predictive value of FC in SSc patients and its’ possible use as a SIBO marker. A total of 40 SSc patients and 39 healthy volunteers were enrolled in the study. All subjects completed questionnaires evaluating gastrointestinal symptoms, FC measurements, and lactulose hydrogen breath test (LHBT) assessing SIBO presence. After rifaximin treatment, patients with SIBO underwent the same diagnostic procedures. Significantly higher FC values were observed in the study group compared to controls (97 vs. 20 μg/g; p < 0.0001) and in SSc patients diagnosed with SIBO compared to SSc patients without SIBO (206 vs. 24 μg/g; p = 0.0010). FC turned out to be a sensitive (94.12%) and specific (73.68%) marker in the detection of SIBO in patients with SSc (AUC = 0.82, 95% CI = 0.66–0.93; p < 0.0001). Our study suggests the potential value of FC in SSc in detecting gastrointestinal impairment and its promising role as an additional diagnostic tool for SIBO.
Collapse
|