Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.

Gastrointestinal Involvement in Systemic Sclerosis Leads to a Wide Range of Symptoms and a Significant Effect On Quality of Life

Thoua1,  Nora M., Bunce2,  Catey, Brough3,  Geraldine, Forbes1,  Alastair, Emmanuel1,  Anton V., Denton3,  Christopher P.

University College London Hospital, London, United Kingdom,
Moorfields Eye Hospital, London, United Kingdom,
UCL Medical School, London, United Kingdom


The gastrointestinal tract (GIT) is affected in up to 90% of patients with systemic sclerosis (SSc). Although the most commonly affected site is the oesophagus, the extent as well as the severity of GIT involvement may vary. GIT involvement may be associated with significant morbidity and in severe cases mortality. With improved survival from cardiopulmonary and renal involvement, gastrointestinal symptoms are becoming more prominent. The im of this study was to establish the frequency and range of GI symptoms in SSc patients at the Royal Free Hospital, a tertiary referral centre.


We used a 52-item, previously validated (Khanna et al), questionnaire to capture SSc-related gut dysfunction. The questionnaire assesses the frequency of 5 categories of symptoms (reflux, distension, diarrhoea, constipation, abdominal pain) and their impact on social functioning and emotional well-being during the previous week. The questionnaire was given to consecutive patients with SSc attending the rheumatology outpatient department. Incomplete questionnaires were excluded from analysis. Patients' notes were reviewed to establish disease subtype, autoantibody profile and other internal organ involvement.


We collected 402 completed questionnaires (357 females; mean age 55, range 18–82). 69% of patients had lcSSc and 30% dcSSc with mean disease duration of 11 years. Mean questionnaire scores showed that patients have a wide range of GI symptoms. 83% of patients were taking medication for GI symptoms despite which 94% reported upper and 79% lower GI symptoms. Only 3% of patients reported no symptoms, and 10% reported daily symptoms. 28% reported significant adverse effect on emotional well being. There was no association between disease subtype or autoantibody profile and GI symptoms. There was a positive correlation between diarrhoea scores (high scores = best health) and pulmonary fibrosis (r=0.134, p=0.0068), suggesting that patients with lung fibrosis were less likely to have diarrhoea. No other association between GI symptoms and other internal organ involvement was found.


GI symptoms, both upper and lower, are common in patients with SSc and have a significant effect on quality of life. Patients should be asked specifically about GI symptoms as they may be under-reported and therefore under-treated. GI focused questionnaire is an effective way to assess gut symptoms and adjust treatment.


1.Khanna, D. et al, Arthr & Rheum 2007; 57: 1280–1286

To cite this abstract, please use the following information:
Thoua, Nora M., Bunce, Catey, Brough, Geraldine, Forbes, Alastair, Emmanuel, Anton V., Denton, Christopher P.; Gastrointestinal Involvement in Systemic Sclerosis Leads to a Wide Range of Symptoms and a Significant Effect On Quality of Life [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1728
DOI: 10.1002/art.26802

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