Background/Purpose: Systemic sclerosis (SSc) is a chronic autoimmune disease affecting multiple organ systems including vascular, musculoskeletal, cardiac, renal, pulmonary, and gastrointestinal (GI). 90% of SSc patients experience GI impairment and severe complications including impaired digestion, emptying, absorption, and peristalsis. The role of diet in SSc is not clear with few studies demonstrating prevalence of fructose intolerance and higher prevalence of celiac disease in undifferentiated connective tissue disease with SSc like features. Currently no consensus on dietary interventions in SSc exists. We aim to examine the impact of diet on symptom burden and quality of life measures in SSc.

Methods: An international randomized controlled single-blind study (IRB #748566) compared effects of a 4-week intervention of gluten-free (GF) vs Mediterranean (M) vs low FODMAP (LF) diets with no restriction on portion/calories. Medication changes were controlled for during the intervention period. Inclusion required a negative celiac test and a checklist from the subject’s rheumatologist confirming ACR/EULAR SSc criteria. Telephone counseling provided diet instruction and support. Patient reported outcomes measures (PROMs) included the Geissen SSc Gastrointestinal (GGI), SSc Gastrointestinal Tract (GIT), SF-36 and adherence questionnaires and were completed via REDCap at 0, 4, and 8 weeks. Data was analyzed by repeated measures analysis and linear mixed model analysis.

Results: Enrollment is ongoing with 51 subjects enrolled and 29 reaching completion (8, 9 and 12, respectively in the GF, M, and LF groups). Of these 29, there were no differences in age, gender, race, or ethnicity. There were no differences between diet groups at 0, 4 or 8 weeks in GGI, GIT, or SF-36. Statistically significant improvements for all groups occurred in the GGI daytime heartburn (p=0.04), nighttime heartburn (p=0.01), difficulty swallowing (p=0.01), and constipation items (p=0.006); in the GIT bloating domain (p=0.02) and overall combined score (p<0.005); and in quality of life (QoL) SF-36 role physical (p=0.02) and vitality (p=0.01) domains. Largest improvements occurred immediately post-intervention (week 4) with waning at week 8 though still significant. Mean adherence was 78.3% with the GF group demonstrating higher adherence (97.2%) than the M and LF groups (73.7% and 72.4% respectively) (p<0.005).

Conclusion: Though no differences related to diet emerged, statistically significant improvements in GI and QoL PROMs occurred in all groups suggesting that increased awareness and purposeful nutrition selection may impact GI symptom burden and overall QoL. Further inquiry is needed with larger sample sizes to determine if premeditated/structured nutrition selection is a worthwhile application in SSc care.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/gastrointestinal-symptom-burden-and-quality-of-life-in-systemic-sclerosis-understanding-the-role-of-diet/