Pseudo-obstruction with Malabsorption and Malnutrition

The rheumatologist has an important role in the identification of pseudo-obstruction, malabsorption, and malnutrition. The Scleroderma Clinical Trials Consortium Gastrointestinal Tract Questionnaire (GIT 2.0) and the Malnutrition Universal Screening Tool (MUST) are validated instrument for evaluation of patient-reported outcomes involving the gastrointestinal tract and is useful for assessing SSc patients. In current clinical practice, computerized tomography (CT) scan of the abdomen is the most accurate modality for identification of pseudo-obstruction. The ability of the gastrointestinal tract to receive and process nutrients is impaired in pseudo-obstruction. Malnutrition may follow from malabsorption as well as food avoidance because of severe postprandial symptoms. The nutrition intervention is largely dependent on the segment of the GI tract affected and the severity and progressive nature of the specific disease process, thus co-management with a dietician and gastroenterologist with expertise in SSc is important.