Christopher Mecoli1, Shivani Purohit1, Nora Sandorfi1, Chris T Derk2. 1. From the Division of Rheumatology, University of Pennsylvania; the Division of Rheumatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.C. Mecoli, MD, Resident in Medicine; C.T. Derk, MD, Associate Professor of Medicine, Division of Rheumatology, University of Pennsylvania; S. Purohit, MD, Fellow in Medicine; N. Sandorfi, MD, Associate Professor of Medicine, Division of Rheumatology, Thomas Jefferson University. 2. From the Division of Rheumatology, University of Pennsylvania; the Division of Rheumatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.C. Mecoli, MD, Resident in Medicine; C.T. Derk, MD, Associate Professor of Medicine, Division of Rheumatology, University of Pennsylvania; S. Purohit, MD, Fellow in Medicine; N. Sandorfi, MD, Associate Professor of Medicine, Division of Rheumatology, Thomas Jefferson University. Chris.Derk@uphs.upenn.edu.
Abstract
OBJECTIVE: Acute intestinal pseudo-obstruction is a rare gastrointestinal manifestation of systemic sclerosis (SSc) with few data existing as to its demographics, clinical course, outcomes, and mortality. METHODS: We undertook a case-control study to describe 64 cases in 37 unique patients, of whom 70% had spontaneous resolution with conservative measures of intravenous hydration and bowel rest, 9% underwent surgical resection, and 25% required prolonged total parenteral nutrition (TPN). RESULTS: Hospital course was for a mean of 12 ± 12.5 days and there was a 16% patient mortality in our population. In a subgroup analysis, patients who had recurrent episodes of pseudo-obstruction were less likely to have esophageal involvement from SSc, and more likely to need prolonged TPN. Mortality tended to be higher in male patients and patients who did not have SSc-related esophageal involvement, and also in patients who had low hemoglobin and serum albumin at presentation. The need for a nasogastric tube for decompression and a surgical intervention correlated with a more prolonged hospital stay. CONCLUSION: To the best of our knowledge, ours is the largest study looking at this rare manifestation of SSc.
OBJECTIVE: Acute intestinal pseudo-obstruction is a rare gastrointestinal manifestation of systemic sclerosis (SSc) with few data existing as to its demographics, clinical course, outcomes, and mortality. METHODS: We undertook a case-control study to describe 64 cases in 37 unique patients, of whom 70% had spontaneous resolution with conservative measures of intravenous hydration and bowel rest, 9% underwent surgical resection, and 25% required prolonged total parenteral nutrition (TPN). RESULTS: Hospital course was for a mean of 12 ± 12.5 days and there was a 16% patient mortality in our population. In a subgroup analysis, patients who had recurrent episodes of pseudo-obstruction were less likely to have esophageal involvement from SSc, and more likely to need prolonged TPN. Mortality tended to be higher in male patients and patients who did not have SSc-related esophageal involvement, and also in patients who had low hemoglobin and serum albumin at presentation. The need for a nasogastric tube for decompression and a surgical intervention correlated with a more prolonged hospital stay. CONCLUSION: To the best of our knowledge, ours is the largest study looking at this rare manifestation of SSc.
Authors: Eric Dein; Pei-Lun Kuo; Yun Soo Hong; Laura K Hummers; Christopher A Mecoli; Zsuzsanna H McMahan Journal: Semin Arthritis Rheum Date: 2019-05-23 Impact factor: 5.532