Gastrointestinal Involvement in Systemic Sclerosis - Review of 250 Patients’ Clinical, Radiological and Serological Profile - A Retrospective Study

Abstract

Background: Gastrointestinal manifestations are common in Systemic Sclerosis, but studies in the Indian population are sparse. Methods: This is a retrospective study of 100 patients who presented to the Department of Clinical Immunology and Rheumatology between 2014 to 2019. The charts and investigations were reviewed for clinical and serological profile, and the investigations done were recorded. Results: 100 patients diagnosed with systemic sclerosis (SSc) who fulfilled the ACR/EULAR 2013 criteria were included in the study-81 patients were classified as diffuse SSc, 15 as limited SSc and 4 as Sine Scleroderma. In total, 72 out of 100 patients reported reflux symptoms and 4 reported chronic diarrhoea. The imaging studies done for the patients and the findings are summarised in Table 1; the indications for endoscopy and the findings are summarised in Table 2. 2 patients were diagnosed with Chronic liver disease. 90 out of 100 patients were treated with a combination of proton pump inhibitors (PPIs) and prokinetics and 10 patients with PPIs alone. H Pylori eradication and antifungal therapy as per scopy findings were administered. 3 patients with chronic diarrhoea were empirically treated with Rifaximin for probable SIBO with symptomatic improvement. Conclusions: GI involvement is common in Scleroderma patients (93%- symptomatic and subclinical combined); however, the symptoms are under reported. Complications of GERD are less common in our popular, probably due to early initiation of PPIs and prokinetics. HRCT identified esophageal dilatation in 79% of the patients. Patients with refractory symptoms need to undergo scopies to rule out infections and malignancies. Further studies are required for better assessment and management of GI symptoms.