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. <Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> Key Points • Pseudo-obstruction is an uncommon manifestation of systemic sclerosis but frequently recurs and is associated with increased mortality. • Severe diarrhoea and long disease duration are associated with an increased risk of pseudo-obstruction. • Pseudo-obstruction occurs more commonly in patients with severe enteric dysmotility and gastric antral vascular ectasia (GAVE). </entry> </row> </tbody> </tgroup> </Table>

Prevalence, clinical characteristics, and hospital course of systemic sclerosis-associated pseudo-obstruction

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2025年10月1日

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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

摘要

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.

Key Points

• Pseudo-obstruction is an uncommon manifestation of systemic sclerosis but frequently recurs and is associated with increased mortality.

• Severe diarrhoea and long disease duration are associated with an increased risk of pseudo-obstruction.

• Pseudo-obstruction occurs more commonly in patients with severe enteric dysmotility and gastric antral vascular ectasia (GAVE).