Dr Alannah Quinlivan PhD candidate, University
of Melbourne, is the Harrison Pennicott Scholarship Recipient funded by Scleroderma Victoria.

Gastrointestinal (GI) symptoms are an extremely common manifestation of Scleroderma (SSc) affecting up to 95% of patients. Any area of the GI system can be affected from the mouth to the anus. The most common GI symptoms seen in SSc patients include dysphagia (difficulty swallowing), reflux, bloating, constipation and diarrhoea.

Additionally, studies have shown us that not only are GI symptoms common in SSc, but they also impact your quality of life, mood, energy levels and how you sleep. This data comes from studies undertaken in many countries around the world, however, the studies looking at GI involvement in Australian patients are lacking.

To this end, a study was undertaken looking at the number of Australian SSc patients suffering from GI involvement and how these symptoms impacted their quality of life (QoL), physical function, mood and energy levels.

Information from 907 SSc patients participating in the Australian Scleroderma Cohort Study was used in this study. The results showed that GI symptoms were common in Australian SSc patients (with 50% of participants reporting moderate to severe symptoms) and that these symptoms negatively impacted their QoL; mood; ability to perform daily tasks; employment; and energy levels. Symptoms of reflux and bloating had the most impact on QoL, physical function, mood and energy levels while diarrhoea had the most impact on employment.

Unfortunately, the usual medications used to treat skin, lung and heart complications in SSc do not improve GI involvement and in some cases, make GI symptoms worse. Reflux is the most common GI symptom seen in SSc and has been linked to interstitial lung disease (ILD). Treatment with anti-reflux medications (such as PPI and H2RA – need to spell these out) not only improves symptoms but can decrease complications from untreated reflux. Therefore, we sought to examine the effect of treating reflux (with PPI or H2RA or a combination of the two) on survival and ILD outcomes in SSc. This study used information from 1640 SSc patients participating in the Australian Scleroderma Cohort Study to answer these questions. Reflux was found to affect 94% of participants to some degree and the treatment of reflux was shown to improve survival. While the presence of reflux did not increase the risk of developing ILD or the severity of ILD, treating reflux improved the survival in patients with reflux and ILD. In fact, more aggressive treatment with both PPI and H2RA was associated with an improved survival compared with treatment with a single agent alone.

Despite the prevalence and impact of GI symptoms in SSc there are few guidelines on how to manage these symptoms. Our hope is that this work will raise awareness of the frequency of GI symptoms.  Additionally, our data shows that proper treatment of reflux can improve survival in SSc, particularly in those with both reflux and ILD.

PPI – Proton pump inhibitor (Nexium, somac)

H2RA- Histamine 2 receptor antagonist (raniditine, zantac)