Introduction Systemic sclerosis (SSc) is a chronic, multi-organ connective tissue disease. Approximately 90% of patients have gastrointestinal (GI) involvement.1In the most severe cases, patients may develop intestinal failure. Malnutrition is common in patients with SSc, with one study finding almost 18% to be at high risk.2However, the relationship between GI symptoms and nutritional risk has not been defined. This study aimed to compare malnutrition risk to GI involvement and patient reported GI symptoms.
Method Unselected outpatients with SSc were recruited over 12 months. Demographics and known GI involvement were recorded. Body mass index (BMI) was determined. Recent unintentional weight loss was assessed and used to calculate the ‘Malnutrition Universal Screening Tool’ (‘MUST’) score.3Patients completed the UCLA GI symptom questionnaire 2.0, which has 7 symptom domains assessing symptom frequency over the past 7 days.4All domains are scored 0–3, except constipation (0–2.5) and diarrhoea (0–2). The total score (0–2.83) is the mean of all scores except constipation. Statistical analysis sought correlations between ‘MUST’ category and GI involvement and questionnaire scores. This study was granted ethical approval.
Results 168 patients were recruited (median age 61 (range 25–81)). 31 (19%) were male. 45 (27%) had diffuse cutaneous SSc. Mean BMI was 24.6 kg/m2(range 15.6–39.8) and 20 (12%) had an unplanned weight loss of >5% in the past 3–6 months. 12% of patients had a high, 14% a medium and 74% a low ‘MUST’ score.
52% had oesophageal and 18% small intestinal dysmotility. ‘MUST’ scores were associated (linear-by-linear analysis) with small intestinal (p = 0.011) but not oesophageal dysmotility (p = 0.179).
The GI symptom score results are shown in the table. There were no associations (Spearman’s) between ‘MUST’ and any of the GI symptom scores.
Conclusion This study shows an association between malnutrition risk (‘MUST’) and GI involvement but not patient reported GI symptoms. Hence, GI symptoms should not be relied upon to identify patients at risk of malnutrition.
Disclosure of interest E. Harrison Grant/Research Support from: Raynaud’s and Scleroderma Association, A. Herrick: None Declared, J. McLaughlin: None Declared, S. Lal: None Declared.
Thoua NM, et al. Rheumatology (Oxford) 2010;49(9):1770–5
Baron M, et al. J Rheumatol. 2009;36(12):2737–43
Weekes CE, et al. Clin Nutr. 2004;23(5):1104–12
Khanna D, et al. Arthritis Rheum 2009;61(9):1257–63