Environment May Contribute to GI Involvement in Scleroderma

In 90% of all scleroderma patients, gastrointestinal (GI) tract problems lead to uncomfortable and dangerous complications. Malnutrition, nausea, vomiting, and diarrhea are among the symptoms that plague GI tract-involved scleroderma patients. Understanding how these problems develop could lead to large gains in quality of life of affected patients and large decreases in economic costs of preventing mortality.

Due to previous data suggesting the involvement of the environment in contributing to GI tract problems in scleroderma, a group in Canada from McMaster University, University of Waterloo, St. Joseph’s Healthcare, Yaoundé Central Hospital, and Hamilton Health Sciences proposed a review of literature to make an informed conclusion on how the environment may impact scleroderma patients. Their outline for conducting the study was published in Systematic Reviews, under the title “Factors Associated with Development of Gastrointestinal Problems in Patients with Scleroderma: A Protocol for a Systematic Review.”

Some of the proposed environmental risk factors are exposure to silica, solvents, epoxy resins, welding fumes, and pesticides. Surprising, some seemingly non-threatening factors such as constant hand and arm vibrations and alcohol use will be considered as potential risk factors. Finally, intestinal microbiota and food consumption will be reviewed for their contribution to symptoms.

The group will use observational studies involving only patients diagnosed with scleroderma by the American College of Rheumatology’s diagnosis criteria during the time period from 1980 to 2013. Patients must have clearly reported GI problems in order to be included in the analysis of specific risk factors.

Overall, the expected benefit of the study is for patients, clinicians, and policy developers. The group believes they can predict severity of disease using the risk factors identified by the study, which may lead to better consideration of disease treatment and reduce morbidity and healthcare costs. These environmental risk factors will be added to biological risk factors such as poor joint health and collagenous colitis.