Prevalence, clinical characteristics, and hospital course of systemic sclerosis-associated pseudo-obstruction
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Date
2025
Authors
Ross, L.
Lin, L.
Hansen, D.
Quinlivan, A.
Stevens, W.
Proudman, S.
Walker, J.
Sahhar, J.
Ngian, G.-S.
Host, L.
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Clinical Rheumatology, 2025; 44(11):4541-4551
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Laura Ross, Lyman Lin, Dylan Hansen, Alannah Quinlivan, Wendy Stevens, Susanna Proudman, Jennifer Walker, Joanne Sahhar, Gene, Siew Ngian, Lauren Host, Mandana Nikpour, Chamara Basnayake
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Abstract
Objective Gastrointestinal involvement is almost universal in patients with systemic sclerosis (SSc). Enteric dysmotility, at its most severe, can present with pseudo-obstruction. In this study, we aimed to quantify the prevalence of SSc pseudo-obstruction and evaluate risk factors for its development. In a subgroup of patients requiring admission to hospital for acute episodes of pseudo-obstruction, we evaluated the clinical course and treatments administered. Methods Using data from 1969 Australian Scleroderma Cohort Study (ASCS) participants, we performed multivariable logistic regression analysis to identify SSc-specific risk factors for pseudo-obstruction. Descriptive statistics were used to examine the clinical course of patients admitted with pseudo-obstruction at a single ASCS centre. Results Pseudo-obstruction occurred uncommonly, affecting 70 (3.56%) ASCS participants. Records of 14 participants with a total of 39 admissions for acute pseudo-obstruction were identified. Pseudo-obstruction was associated with longer disease duration (OR 1.03, p = 0.03), bowel dysmotility (OR 4.51, p < 0.01), small intestinal bacterial overgrowth (OR 2.81, 95% CI (1.00–1.05), p < 0.01), and gastric antral vascular ectasia (OR 2.52, 95% CI 1.28–4.94, p < 0.01). Severe diarrhoea, as measured by the UCLA Gastrointestinal 2.0 questionnaire, was the only clinical symptom significantly associated with episodes of pseudo-obstruction (OR 3.39, 95% CI 1.56–7.38, p < 0.01). Opioids were more commonly prescribed in patients with pseudo-obstruction but were not significantly associated with pseudo-obstruction in multivariable analysis (OR 1.24, 95% CI 0.62–2.48, p = 0.54). Patients with a history of pseudo-obstruction were more likely to require enteral (4.29% vs. 0.21%, p < 0.01) or parenteral nutrition (7.14% vs. 0.16%, p < 0.01). Conclusion Pseudo-obstruction is associated with other severe gastrointestinal manifestations and is associated with malnutrition in SSc patients. Future studies are required to assess the impact of treatment of SSc-associated enteric dysmotility to prevent progression to pseudo-obstruction.
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© The Author(s) 2025. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.