Abstract
Background and objectivesThe University of California Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract Instrument 2.0 (UCLA GIT 2.0) is validated to capture gastrointestinal (GI) tract morbidity in patients with systemic sclerosis (SSc). The aims of this study were to determine in a large SSc cohort if the UCLA GIT 2.0 is able to discriminate patients for whom a rheumatologist with experience in SSc would recommend an esophago-gastro-duodenoscopy (EGD), and if it could identify patients with endoscopically proven esophagitis or with any pathologic finding on EGD.MethodsWe selected patients fulfilling the ACR/EULAR 2013 criteria for SSc from our EUSTAR center having completed at least once the UCLA GIT 2.0 questionnaire, and we collected data on gastrointestinal symptoms and EGD from their medical charts. We analyzed by general linear mixed effect models several parameters, including UCLA GIT 2.0, considered as potentially associated with the indication of EGD, as well as with endoscopic esophagitis and any pathologic finding on EGD.ResultsWe identified 346 patients (82.7% female, median age 63 years, median disease duration 10 years, 23% diffuse cutaneous SSc) satisfying the inclusion criteria, who completed UCLA GIT 2.0 questionnaires at 940 visits. EGD was recommended at 169 visits. In multivariable analysis, UCLA GIT 2.0 and some of its subscales (reflux, distention/bloating, social functioning) were associated with the indication of EGD. In 177 EGD performed in 145 patients, neither the total ULCA GIT 2.0 score nor any of its subscales were associated with endoscopic esophagitis, nor with any pathologic EGD findings.ConclusionsIn a real-life setting, the UCLA GIT 2.0 and its reflux subscale were able to discriminate patients with SSc who had an indication for EGD, but did not correlate with findings in EGD. We conclude that, while using the UCLA GIT 2.0 in the routine care of patients with SSc may help the rheumatologist to better understand the burden of GI symptoms in the individual patient, it should not be used as a stand-alone instrument to identify an indication of EGD.
Highlights
In patients with systemic sclerosis (SSc), the gastrointestinal (GI) tract is the most common internal organ involvement, with over two thirds of patients reporting GI symptoms [1]
While using the UCLA GIT 2.0 in the routine care of patients with SSc may help the rheumatologist to better understand the burden of GI symptoms in the individual patient, it should not be used as a stand-alone instrument to identify an indication of EGD
We further identified by receiver operating characteristic (ROC) curve analysis, selecting the values with the largest area under the curve (AUC) and significant 95% confidence intervals, cutoffs for the reflux, and total UCLA GIT 2.0 score discriminating best between patients with recommendation to perform EGD and those without
Summary
In patients with systemic sclerosis (SSc), the gastrointestinal (GI) tract is the most common internal organ involvement, with over two thirds of patients reporting GI symptoms [1]. The most prevalent GI manifestation is esophageal involvement due to hypomotility and gastroesophageal reflux, the latter often leading to esophagitis and in later stages to Barrett’s esophagus [4]. Another GI manifestation of SSc is gastric antral vascular ectasia (GAVE) which may cause severe anemia [5]. There are no recommendations or guidelines when to perform endoscopic and functional investigation of the upper GI tract in patients with SSc. Esophago-gastro-duodenoscopy (EGD) plays a major role in the diagnosis of reflux esophagitis, esophageal strictures, Barrett’s esophagus, and adenocarcinoma of the esophagus. The aims of this study were to determine in a large SSc cohort if the UCLA GIT 2.0 is able to discriminate patients for whom a rheumatologist with experience in SSc would recommend an esophago-gastro-duodenoscopy (EGD), and if it could identify patients with endoscopically proven esophagitis or with any pathologic finding on EGD
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