Presentation: Lower Gastrointestinal Symptoms and Quality of Life in Patients with Systemic Sclerosis. A Population-Based Study (2007)

17 Lower Gastrointestinal Symptoms and Quality of Life in Patients with Systemic Sclerosis. A Population-Based Study

PURPOSE: To systematically evaluate symptoms from colon and rectum in a population-based cohort of Systemic Sclerosis patients and compare the results to Health-Related Quality of Life (HR-QOL).
METHOD: 79 SSc patients were compared to 158 age, sex and home municipality matched controls. Information regarding symptoms were collected from a validated questionnaire and HR-QOL was evaluated from Medical Outcomes Study Short Form Health Survey (SF-36). Modified Miller Score (MMS), a composite score measuring fecal incontinence, was computed.
RESULTS: Patients reported more extreme values for frequency of evacuation and more often needed to use both laxatives and manual assistance in order to facilitate evacuation. Involuntary release of loose stools was reported by 33% of the SSc patients compared to 11% of the control persons and of hard stools by 11% of the patients vs 2% of the controls (p<0.05, Mantel-Haenszel). Patients also differed compared to controls in that the leakage more frequently happened without previous sensation as well as soiling of underwear. Protective pads were more often used in the SSc patient group. The ability for anorectal discrimination, sensibility and deferring defecation was considerably diminished in SSc patients (p<0.005) while MMS was higher compared to control persons (p<0.001, Wilcoxon signed rank test). Of the patients, 22% of the reported ≥5 irritable bowel syndrome (IBS) -like symptoms compared to 3% of the control persons (p<0.001).
Patients had lower scores in all domains of the SF-36, i e worse HR-QOL, than controls. Patients with the diffuse form of the disease (dcSSc) had lower scores than those individuals with the limited form (lcSSc) but there was no correlation between any subset of the disease and GI symptoms. General well being was affected by the bowel function in 30 % of the patients and social life in 20%. Twenty % of the patients compared to 8% of the control persons felt the need for a strict diet because of bowel problems (p=0.008). MMS correlated with the General Health (GH) domain of SF-36 and with the patient comprehension of bowel problems being troublesome to the general health and social life. Those patients who reported irritable bowel-like symptoms and those who needed to keep a strict diet because of bowel problems had lower SF-36 scores than those without these symptoms.
CONCLUSIONS: Patients with SSc have a high frequency of colorectal symptoms, especially fecal incontinence. 30% of the patients reported that their bowel function affected their general well-being which was also reflected by a positive correlation between Miller Score and the GH domain of the SF-36.

 K. Franck-Larsson, None; W. Graf, None; A. Rönnblom, None.