Gastrointestinal Transit Abnormalities Associated With Severe GI Symptoms in Scleroderma

Delayed transit in the small bowel and colon were found to be associated with more severe gastrointestinal (GI) complications in patients with scleroderma, according to study results published in Arthritis Care & Research.

Previous studies have reported that various factors may affect the risk for gastrointestinal complications in patients with scleroderma, including diet, microbiota dysbiosis, and abnormal GI transit.

The objective of the current study was to determine the association between GI transit abnormalities and the severity of bowel dysfunction and gastrointestinal symptoms, using the Medsger GI severity score and the University of California (UCLA) Scleroderma Clinical Trial Consortium GIT 2.0, respectively. 

The study included 71 patients (mean age, 41±14 years; 85.9% women; 70% with limited cutaneous disease) with scleroderma and GI symptoms from the Johns Hopkins Scleroderma Center in Baltimore, Maryland, and 18 healthy control participants. All participants underwent whole-gut transit scintigraphy for the assessment of GI transit from the esophagus to the colon.  

Gastrointestinal transit time, measured by whole-gut scintigraphy, was significantly different between patients with scleroderma and healthy control participants; 80% of patients with scleroderma had evidence for more than 1 abnormal region of the gut.

The esophagus and colon were most frequently found to have abnormal readings across all categories of the Medsger GI scores. Small bowel transit delay was not common among patients with Medsger GI scores from 0 to 3 (11%), but all patients with the most severe Medsger category of GI disease (total parenteral nutrition) had small bowel involvement (P <.01).

Patients with pseudo-obstruction and/or malabsorption syndrome (Medsger GI scores of 3) were more likely to have severe colonic transit delay, as 70% of these patients had 30% or less colonic emptying at 72 hours (P =.07), suggesting the importance of colonic motility in patients with scleroderma.

There was a correlation between symptoms based on UCLA GIT 2.0 scores with objective GI transit abnormalities in patients with scleroderma. Researchers reported a moderate inverse association between UCLA GIT 2.0 gastroesophageal reflux disease domain scores and esophageal transit times (r=-0.31, P =.05) and gastric emptying (r=-0.32, P =.05).

The study had several limitations, including the known lack of standardization in whole-gut scintigraphy protocols and interpretation, the time interval between the symptom surveys and the scintigraphy study, and the lack of assessment of the effect of disease-modifying agents on scintigraphy results.

“These data are important in providing evidence that [systemic sclerosis] bowel disease affects transit of GI content and that delay in transit accounts in part for both bowel symptoms and Medsger GI severity,” the researchers concluded.

Reference

McMahan ZH, Tucker AE, Perin J, et al. The relationship between gastrointestinal transit, Medsger GI severity, and UCLA GIT 2.0 symptoms in patients with systemic sclerosis. Arthritis Care Res (Hoboken). Published online, October 16, 2020. doi:10.1002/acr.24488