title: Lower gastrointestinal symptoms and quality of life in patients with systemic sclerosis: a population-based study.
abstract: OBJECTIVE
  To investigate the frequency and nature of bowel symptoms in a population-based cohort of patients with systemic sclerosis (SSc), compared with healthy controls, and to relate these symptoms to health-related quality of life (HR-QOL).
  
  
  METHODS
  Seventy-nine SSc patients and 158 matched controls answered a validated questionnaire on gastrointestinal (GI) symptoms and Medical Outcomes Study Short Form Health Survey (SF-36). Modified Miller Score, a composite score measuring faecal incontinence, was computed.
  
  
  RESULTS
  Abnormal stool consistency, bloating, a feeling of incomplete evacuation, faecal incontinence and rectal bleeding were more frequently reported by SSc patients than controls. The ability for anorectal discrimination, and deferring defecation was diminished in SSc patients. Bowel function affected general well being in 30% of patients and social life in 20%. Patients had lower SF-36 scores, that is, worse HR-QOL than controls. Modified Miller Score did not correlate to the SF-36 scores in patients, but other lower GI symptoms, especially abdominal pain and bloating, were associated with diminished HR-QOL.
  
  
  CONCLUSIONS
  Lower GI symptoms, including faecal incontinence, are more common in patients with SSc than in healthy controls and are of consequence to the individual patient's life. The lower prevalence of anorectal discrimination in the SSc patients suggests a neuronal defect in these patients. Increased awareness of these symptoms might stimulate a search for new diagnostic and therapeutic strategies.
authors.affiliation: Department of aMedical Sciences, University Hospital, Uppsala, Sweden. karin.franck-larsson@medsci.uu.se
authors.forename: Karin
authors.initials: K
authors.lastname: Franck-Larsson
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Graf
authors.forename: Anders
authors.initials: A
authors.lastname: Rönnblom
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003672:Defecation; D005242:Fecal Incontinence / Q000209:etiology / Q000523:psychology / Q000534:rehabilitation; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology* / Q000523:psychology / Q000534:rehabilitation; D006306:Health Surveys; D006801:Humans; D007398:Interpersonal Relations; D043183:Irritable Bowel Syndrome / Q000209:etiology / Q000523:psychology / Q000534:rehabilitation; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012595:Scleroderma, Systemic / Q000150:complications* / Q000523:psychology / Q000534:rehabilitation; D012720:Severity of Illness Index; D055815:Young Adult