Impact of gastrointestinal involvement on mortality and malnutrition in systemic sclerosis: an observational cohort of 135 patients.

To describe the characteristics and outcomes of gastrointestinal involvement (GI) in patients with systemic sclerosis (SSc). We also assessed the impact of GI on mortality, hospitalizations, and undernutrition and identified the subgroup affected by chronic intestinal pseudo-obstruction (CIPO). We conducted an observational monocentric study including 135 consecutive patients with SSc and evaluated clinical and paraclinical data, laboratory data and nutritional data at disease onset and at the last follow-up over a median follow-up of 89 months. We assessed hospitalizations and their main causes at 6 years. A total of 135 patients with SSc (95 women, median age 57 years) were included. GI affected 116 patients (86%) over the entire follow-up period, with gastroesophageal reflux as the main complaint (70%). The anti-Pm/Scl antibody seems to be predictive of secondary GI, with a greater prevalence in this group (p = 0.007). Undernutrition was present exclusively in patients with GI (p = 0,01) and affected 22% of patients at the last follow-up, with a higher mortality risk (38% vs. 11%, Fischer p = 0.001; CI 95% [1.88–13.28]). It affected older patients (p = 0.004), with greater muscular involvement (p = 0.02) and higher levels of acute phase reactants (p = 0.01). CIPO affected 8% of our cohort (n = 8) and appears mostly within the first 6 years after the onset of SSc. Digestive tract involvement affects almost all patients and should be recognized as an integral aspect of SSc care. Undernutrition is a severe complication and should be detected as part of GI.