title: Factors associated with development of gastrointestinal problems in patients with scleroderma: a systematic review.
abstract: BACKGROUND
  Up to 90% of people with scleroderma have gastrointestinal (GI) problems such as constipation, bloating, diarrhea, and malabsorption. These problems significantly impair quality of life. Our objective was to determine the risk factors for gastrointestinal issues in people with scleroderma.
  
  
  METHODS
  We conducted a systematic review of observational studies that report GI problems in patients with scleroderma along with the associated risk factors. We were interested in any GI problem and any risk factor as long as the study included patients diagnosed with scleroderma according to the 1980 or 2013 American College of Rheumatology guideline. We searched the following databases: CINAHL, EMBASE, LILACS, MEDLINE, and Web of Science for relevant articles from June 1884 to May 2014. Two authors independently screened citations and full text articles and extracted data. Discrepancies were resolved by consensus or by consulting a third author. Methodological quality of included studies was assessed using the Newcastle-Ottawa Scale.
  
  
  RESULTS
  After removing duplicates, 645 unique citations were identified. A total of three studies, three cross-sectional (n = 64, n = 42, n = 606), were included in this systematic review. Collectively, these three studies explored Helicobacter pylori and smoking status as risk factors. We found conflicting evidence on the role of H. pylori with two studies showing opposite yet statistically significant results. One moderate quality study showed smoking as a risk factor. Key limitations include the small sample sizes of two studies and poor study designs to draw causal links.
  
  
  CONCLUSIONS
  There is insufficient evidence to describe the risk factors for GI problems in patients with scleroderma. Longitudinal observational studies are warranted in patients with scleroderma.
  
  
  BACKGROUND
  PROSPERO CRD42014010707.
authors.affiliation: Bachelor of Health Sciences (Honours) Program, McMaster University, Hamilton, ON, Canada. brian.youn.hong@learnlink.mcmaster.ca.
authors.forename: Brian Younho
authors.initials: BY
authors.lastname: Hong
authors.affiliation: Statistics for Health (Honours), University of Waterloo, Waterloo, ON, Canada. rgiang@uwaterloo.ca.
authors.forename: Raymond
authors.initials: R
authors.lastname: Giang
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. mbuagblc@mcmaster.ca.|Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare, 50 Charlton Avenue East, 3rd Floor Martha Wing, Room H325, Hamilton, ON, L8N 4A6, Canada. mbuagblc@mcmaster.ca.|Centre for Development of Best Practices in Health, Yaoundé Central Hospital, Yaoundé, Cameroon. mbuagblc@mcmaster.ca.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Mbuagbaw
authors.affiliation: Division of Rheumatology, Departments of Medicine and Paediatrics, St. Joseph's Healthcare, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada. mlarche@mcmaster.ca.
authors.forename: Maggie
authors.initials: M
authors.lastname: Larche
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. thabanl@mcmaster.ca.|Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare, 50 Charlton Avenue East, 3rd Floor Martha Wing, Room H325, Hamilton, ON, L8N 4A6, Canada. thabanl@mcmaster.ca.|Departments of Paediatrics and Anaesthesia, McMaster University, Hamilton, ON, Canada. thabanl@mcmaster.ca.|Centre for Evaluation of Medicine, St. Joseph's Healthcare, Hamilton, ON, Canada. thabanl@mcmaster.ca.|Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada. thabanl@mcmaster.ca.
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
mesh_terms: D004781:Environmental Exposure / Q000009:adverse effects*; D005767:Gastrointestinal Diseases / Q000209:etiology* / Q000503:physiopathology; D016481:Helicobacter Infections / Q000150:complications* / Q000382:microbiology; D006801:Humans; D064887:Observational Studies as Topic; D011788:Quality of Life; D012107:Research Design; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000150:complications* / Q000503:physiopathology; D012907:Smoking / Q000009:adverse effects*