Session Type: Abstract Submissions (ACR)
Acute intestinal pseudo-obstruction is a rare gastrointestinal manifestation of SSc with little data existing as to the demographics, clinical course, outcomes and mortality of this disease. With this study we attempt to describe the mortality, recurrence and hospital course of these patients.
We undertook a retrospective chart review of patients admitted at two University Medical Centers in the city of Philadelphia over an 11.5 year period (1/2001-6/2012). Medical records were searched using ICD codes for SSc in combination with ICD codes for intestinal obstruction and fecal impaction. The medical records were then reviewed for those patients who were identified as true cases of pseudo-obstruction and we collected information regarding demographic data, laboratory and radiological studies, hospital presentation and course, medical and surgical treatment, outcomes and mortality. Continuous variables were analyzed by student’s unpaired two-tailed t test while categorical variables by Fisher’s exact test.
A total of 1,733 admissions of SSc patients to the two hospitals were identified during the time period in question. 103 admissions had ICD codes matching our search criteria and from them 64 admissions were identified as true acute intestinal pseudo-obstruction cases in 37 unique SSc patients. From these cases 73% had spontaneous resolution with conservative measures of IV hydration and bowel rest, 11% underwent surgical resection and 26% required permanent total parenteral nutrition (TPN). Hospital course was for a mean of 12+12.5 days and there was 10% mortality. In a subgroup analysis of patients who had recurrent episodes of pseudo-obstruction this was more commonly seen in women (p=0.01), associated with symptoms of nausea at presentation (p=0.04) and resulted more often to the use of prolonged TPN (p<0.0001). Mortality was higher in male patients (p=0.014) who had low hemoglobin ( p<0.00008) and serum albumin (p<0.001). Patients who underwent surgery were more likely to die as compared to patients who did not (p<0.005). A prolonged hospital stay was more often related to the use of a nasogastric tube (p<0.05) and surgical resection (p<0.05). Conclusion:
Acute intestinal pseudo-obstruction is a rare cause of hospitalization of SSc patients (64/1733 (3.7%) admissions). This is the largest study attempting to characterize this subpopulation of SSc patients. Based on our results most patients have spontaneous resolution with conservative measures such as bowel rest and IV hydration. Women were more likely to have recurrences and these patients were more likely to suffer from nausea at their presentation, and progressed to need permanent TPN. Mortality was higher in males especially in those patients with a low hemoglobin and serum albumin at presentation. Patients who underwent a surgical resection had a higher mortality and a more prolonged hospital stay.
C. T. Derk,
Actelion Pharmaceuticals US,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mortality-recurrence-and-hospital-course-of-patients-with-systemic-sclerosis-related-acute-intestinal-pseudo-obstruction/