faecal incontinence in systemic sclerosis
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∙1Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, Quebec.
∙2Division of Rheumatology, Nova Scotia Rehabilitation Centre, Dalhousie University, Halifax, Nova Scotia.
∙3Division of Rheumatology, St Joseph's Healthcare, McMaster University, Hamilton.
∙4Division of Rheumatology, St Joseph Health Care, University of Western Ontario, London, Ontario.
∙5Department of Biostatistics, Centre HospitalierUniversitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke.
∙6Division of Rheumatology, CHU de Québec, Université Laval, Quebec City, Quebec.
∙7Division of Rheumatology, Southlake Regional Health Centre, Newmarket, Ontario.
∙8Division of Rheumatology, Centre HospitalierUniversitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada ariel.masetto@usherbrooke.ca.
Abstract
OBJECTIVES:
The aim was to establish the prevalence and severity of faecal incontinence (FI) in SSc, its association with other intestinal manifestations and potential predictors of FI, and its impact on quality of life.
METHODS:
A multicentre, cross-sectional study of 298 SSc subjects followed in the Canadian
Scleroderma Research Group cohort was performed using validated questionnaires:
Jorge-Wexner score (an FI severity scale), Bristol stool scale (a visual scale of stool
consistency) and FI Quality-of-Life scale. Constipation was defined by the Rome III criteria.
Associations between the Jorge-Wexner score and other clinical variables were
determined using multivariate regression analyses.
RESULTS:
Eighty-one (27.2%) subjects had FI, which was mild in 37 (12.4%) and moderate to
severe in 44 (14.8%). Most patients had well-formed stools, 111 (38.8%) reported
constipation and 38 (13.4%) had been previously treated for small intestinal bacterial
overgrowth (SIBO). Variables independently associated with FI were: loose vs
well-formed stools [odds ratio (OR) = 7.01, 95% CI: 2.09, 23.51)], constipation (OR = 3.64, 95% CI: 1.61, 8.27, P = 0.002), history of SIBO (OR = 2.97, 95% CI: 1.06, 8.27) and urinary incontinence (OR = 2.45, 95% CI: 1.14, 5.27). Quality of life measured with the FI Quality-of-Life scale was inversely correlated with FI severity (correlation coefficients between -0.602 and -0.702, P < 0.001).
CONCLUSION:
FI was common and often severe in SSc. Loose stools, SIBO, constipation and urinary incontinence were strongly associated with FI. Other than targeting anorectal dysfunction, concomitant treatment of clinical correlates could lead to improvement in FI and quality of life in SSc.。