AB0662 Elevated fecal calprotectin in early systemic sclerosis

Abstract

BackgroundGastrointestinal (GI) morbidity is prevalent in systemic sclerosis (SSc), causing a reduction in quality of life and increased mortality, but has been difficult to assess objectively [1]. Elevated levels of fecal calprotectin (F-cal), a biomarker of GI inflammation, has previously been observed in patients with SSc [2]. F-cal has not been explored in early SSc and its diagnostic potential in the classification of SSc has not been studied.ObjectivesOur objectives were; 1) study F-cal levels in early SSc; 2) investigate the discriminatory power of F-cal; 3) explore F-cal in relation to GI features of SSc.MethodsConsecutive referred patients with suspected new-onset SSc without concurrent non-SSc GI disease were invited to this study. Patients were classified as SSc if meeting ACR-EULAR criteria, or SSc mimickers if they did not. GI symptoms and use of NSAID or PPI was noted. F-cal was measured and levels >50ug/g were classified as elevated. F-cal was also measured in age- and sex matched controls without rheumatological disease.ResultsOf 137 patients, 92 were classified as SSc and 45 as SSc mimickers. Elevated F-cal was significantly more common in SSc patients compared to the control group (38% vs 7.3%; p < 0.001) but not compared to the SSc mimicker patients (38% vs 31%; p = 0.427). The median F-cal level was higher in SSc patients compared to controls (35 µg/g vs ≤30 µg/g; p ≤ 0.001) but not compared to the SSc mimicker patients (35 µg/g vs ≤30 µg/g; p = 0.248). Elevated F-cal was not associated with any GI symptoms. Elevated F-cal was more common in patients who used PPI (OR 7.14; 95% CI 2.56-29.93; p < 0.001).ConclusionIn this study, we demonstrate that elevated levels of F-cal are prevalent already in the early stages of SSc. These results are in line with previous data suggesting that GI involvement may be present in early SSc.Table 1.Frequency of GI features and association to F-cal elevation (n = 92)GI features (n, %)Normal F-cal, n = 57Elevated F-cal, n = 35Odds Ratio (95% CI)Dysphagia19 (35%)12 (34%)0.99 (0.41-2.41)Reflux symptoms33 (59%)23 (68%)1.46 (0.60-3.56)Fecal incontinence9 (16%)3 (8.6%)0.50 (0.08-2.22)Patient-reported involuntary weightloss11 (20%)8 (23%)1.21 (0.43-3.39)Dilated esophagus on HRCT8 (16%)8 (28%)1.95 (0.64-5.94)NSAID use12 (21%)6 (17%)0.78 (0.26-2.30)PPI use23 (40%)29 (83%)7.14 (2.56-19.93)Figure 1.F-cal measurements by group. Median value represented by horizontal bar.