Fecal Incontinence and Association with Bowel Dysfunction in Systemic Sclerosis: A Canadian Multicenter Study

Nicolas Richard^1,2, Marie Hudson², Genevieve Gyger², Murray Baron³, Evelyn Sutton⁴, Nader A. Khalidi⁵, Janet E. Pope⁶, Nathalie Carrier¹, Maggie J. Larche⁵, Alexandra Albert⁷, Paul R. Fortin⁷, Carter Thorne⁸, Ariel Masetto⁹ and Canadian Scleroderma Research Group, ¹Université de Sherbrooke, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada, ²McGill University, Jewish General Hospital, Montreal, QC, Canada, ³Rheumatology, McGill University, Jewish General Hospital, Montreal, QC, Canada, ⁴Rheumatology, Dalhousie University, Nova Scotia Rehabilitation Centre, Halifax, NS, Canada, ⁵McMaster University, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada, ⁶Monsignor Roney Bldg/Rheum, University of Western Ontario, St Joseph Health Care, London, ON, Canada, ⁷Université Laval, CHU de Québec, Québec, QC, Canada, ⁸Southlake Regional Health Centre, Newmarket, ON, Canada, ⁹Department of Medicine/Division of Rheumatology, Université de Sherbrooke, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Bowel, gastrointestinal complications, scleroderma and systemic sclerosis

Session Information

Date: Sunday, November 8, 2015

Title: Systemic Sclerosis, Fibrosing Syndromes and Raynaud's - Clinical Aspects and Therapeutics Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Gastrointestinal (GI) tract involvement is a common and serious complication of systemic sclerosis (SSc). However, the prevalence of fecal incontinence (FI) and its relationship with other GI symptoms in SSc remain largely unknown. In this study, we aimed to establish the prevalence and severity of FI in an SSc cohort, to study the association between FI and constipation, small intestinal bacterial overgrowth (SIBO) and other potential predictors of FI, and to determine the impact of FI on health-related quality of life (HRQoL) in SSc.

Methods: We performed a multicenter, cross-sectional study of 271 patients with SSc followed in the Canadian Scleroderma Research Group registry (CSRG). In addition to the standardized data collection protocol, participants were asked to complete three validated questionnaires: Bristol stool scale (BSS; measuring consistency of stool from 1, being hardest, to 7, being completely liquid stool), Jorge-Wexner score (JWS; FI severity score ranging from 0-20, with 20 being most severe), and Fecal Incontinence Quality of Life scale (FIQOL; measuring 4 domains: lifestyle, coping/behaviour, depression/self perception, embarrassment). The Rome III criteria were used to define constipation. Descriptive statistics and multivariate regression analyses were generated to determine associations between the JWS and other clinical variables.

Results: Mean age was 59.3±12.1 years, 87.4% were women, median (interquartile range, IQR) disease duration was 10.3 (6.6-17.8) years and 30.0% had diffuse cutaneous SSc. Median BSS was 4.0 (3.0-4.0), 103 (39.6%) subjects met the criteria for constipation and 34 (13.2%) had been treated with antibiotics for SIBO since disease onset. FI, defined as a JWS ≥5, was identified in 74 (27.3%) subjects; among them 33 (12.2%) were mild (score 5-9) and 41 (15.1%) moderate to severe (score ≥10).

In multivariate logistic regression analyses, variables associated with FI were (OR (95% confidence interval)): loose (BSS≥6) vs well-formed (3≤BSS<6) stools (5.93 (1.81-19.42), p=0.003); history of forcep use at time of delivery (2.37 (1.13-4.94), p=0.022); constipation (3.21 (1.46-7.06), p=0.004) and history of antibiotic use for SIBO (4.82 (1.88-12.32), p=0.001). Other variables associated with FI in univariate but not multivariate analyses included advancing age (p=0.031), female gender (p=0.002), urinary incontinence (p<0.001), use of stool softeners (p=0.022) and domperidone (p=0.034). No difference was found with disease duration (p=0.918), limited or diffuse cutaneous disease subsets (p=0.670) or SSc-specific antibodies (all p >0.4). HRQoL decreased significantly as severity of fecal incontinence increased (correlation coefficients of JWS with all 4 domains of FIQOL between -0.6 and -0.7, all p<0.001).

Conclusion: In this multicenter study, FI was common and often severe in SSc. Loose stools, SIBO, as well as constipation were strongly associated with FI. FI had a strong negative impact on HRQoL. These data can inform the design of future interventional studies aimed at improving the management of FI and HRQoL in SSc.

Disclosure: N. Richard, None; M. Hudson, None; G. Gyger, None; M. Baron, None; E. Sutton, None; N. A. Khalidi, None; J. E. Pope, None; N. Carrier, None; M. J. Larche, None; A. Albert, None; P. R. Fortin, None; C. Thorne, None; A. Masetto, None.

To cite this abstract in AMA style:

Richard N, Hudson M, Gyger G, Baron M, Sutton E, Khalidi NA, Pope JE, Carrier N, Larche MJ, Albert A, Fortin PR, Thorne C, Masetto A. Fecal Incontinence and Association with Bowel Dysfunction in Systemic Sclerosis: A Canadian Multicenter Study [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/fecal-incontinence-and-association-with-bowel-dysfunction-in-systemic-sclerosis-a-canadian-multicenter-study/. Accessed .

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