Quantifying the Prevalence of Disorders of Gut Brain Interaction in Systemic Sclerosis

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INTRODUCTION: Systemic sclerosis (SSc) is a rare autoimmune disease with near-universal symptoms of gastrointestinal dysmotility. The contribution of disruption of the gut-brain axis to SSc gastrointestinal symptoms is unknown. We aimed to quantify the frequency of SSc patients meeting diagnostic criteria for DGBI-like symptoms. METHODS: In a cross-sectional survey study, the frequency of irritable bowel syndrome (IBS), functional dyspepsia (FD), functional dysphagia and post prandial distress syndrome (PPDS) was assessed using the Rome-IV-Questionnaire. Participants completed a Short Form-36, Health Assessment Questionnaire Disability Index, UCLA Gastrointestinal 2.0 Questionnaire (GIT 2.0), and ScleroID to assess quality of life, daily function, SSc gastrointestinal disease severity, and overall impact of SSc, respectively. The associations between IBS, FD, functional dysphagia, PPDS, and SSc severity, daily function, and quality of life were assessed using linear regression analysis. RESULTS: Out of 101 participants, 21 met FD criteria, and 18 met IBS criteria. These patients had more severe SSc gastrointestinal disease, measured by total GIT-2.0 scores (IBS coef: 0.69 (0.44-0.95, p < 0.01); FD coef: 0.64 (0.41-0.86, p < 0.01)). FD was associated with poorer physical health-related quality of life (SF-36 PCS coef: 38.70 (28.54-48.66)), and both IBS and FD were associated with a greater overall impact of SSc as measured by the ScleroID (IBS coef: 1.55 (0.35-2.75), p < coef: 1.94 (0.89-2.98, p < 0.001)). CONCLUSION: One-fifth of SSc patients surveyed met DGBI diagnostic criteria, suggesting that the presence of disorders of gut-brain interaction should be considered when assessing SSc gastrointestinal disease. Our results indicate that there may be a subgroup of SSc patients who have co-existing DGBI-like symptoms contributing to their clinical presentation of SSc-associated gastrointestinal disease.

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