Performance of the UCLA Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.0 Instrument as a Clinical Decision Aid in the Routine Clinical Care of Patients With Systemic Sclerosis

Abstract

Background and objectivesThe University of California Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract Instrument 2.0 (UCLA GIT 2.0) is validated to capture gastrointestinal (GI) tract morbidity in patients with systemic sclerosis (SSc). The aims of this study were to determine in a large SSc cohort if the UCLA GIT 2.0 is able to discriminate patients for whom a rheumatologist with experience in SSc would recommend an oesophago-gastro-duodenoscopy (EGD), and if it could identify patients with endoscopically proven oesophagitis or with any pathologic finding on EGD. Methods We selected patients fulfilling the ACR/EULAR 2013 criteria for SSc from our EUSTAR center having completed at least once the UCLA GIT 2.0 questionnaire, and we collected data on gastrointestinal symptoms and EGD from their medical charts. We analysed by general linear mixed effect models several parameters, including UCLA GIT 2.0, considered as potentially associated with the indication of EGD, as well as with endoscopic oesophagitis and any pathologic finding on EGD.Results We identified 346 patients (82.7% female, median age 63 years, median disease duration 10 years, 23% diffuse cutaneous SSc) satisfying the inclusion criteria, who completed UCLA GIT 2.0 questionnaires at 940 visits. EGD was recommended at 169 visits. In multivariable analysis, UCLA GIT 2.0 and some of its subscales (reflux, distention/bloating, social functioning) were associated with the indication of EGD. In 177 EGD performed in 145 patients, neither the total ULCA GIT 2.0 score nor any of its subscales were associated with endoscopic oesophagitis, nor with any pathologic EGD findings.ConclusionsIn a real-life setting, the UCLA GIT 2.0 was able to detect patients with SSc who had an indication for EGD. This supports the utilization of the UCLA GIT 2.0 as a decision aid in routine care for upper GI tract investigation of patients with SSc.