Risk factors for development of severe gastrointestinal dysmotility in patients with systemic sclerosis

Abstract

Background Systemic Sclerosis (SSc) is an autoimmune condition of unknown etiology. We aim to investigate incidence, characteristics, and risk factors for gastrointestinal (GI) dysmotility in patients diagnosed with SSc using Cerner HealthFacts, a national longitudinal database representing approximately 69 million patients. Methods All patients over 18 years of age with SSc were included in our analysis. Incidence of GI dysmotility was identified using ICD coding. Patient characteristics were evaluated as potential risk factors for development of GI dysmotility using multivariable regression built using all variables with p<0.1 on univariable analysis. Results Overall, 0.4% (58/13,930) of patients with SSc developed GI dysmotility. Mean age was 57.23±15.22 years and 16% (2,228/13,930) were male and 86.1% (11,502/13,930) were female. In terms of race, 70.15% (9,772/13,930) were white and 14.82% (2,064/13,930) were African American. 92.51% (12,886/13,930) received care at an acute care facility and 81.51% (11,354/13,930) received care at an urban facility. The variables which conferred the highest odds of developing GI dysmotility included presence of hepatic comorbidities (OR 2.35), digestive comorbidities (OR 6.8), muscular dystrophy (OR 569.2), and Raynaud (OR 1.98). In univariable analysis and multivariable regression with 95% CI; 4 variables were predictive for GI dysmotility, and none were protective against GI dysmotility. Conclusions In this longitudinal national database study of patient with diagnosed SSc - hepatic, digestive comorbidities, muscular dystrophy, and Raynaud were noted to be associated with high risk of developing GI dysmotility. Careful evaluation and follow up is advised for SSc patients. Supported by None

An Interesting Case of Disseminated Histoplasmosis in a Patient With Hemophagocytic Lymphohistiocytosis

“…Her preceding pulmonary symptoms and weight loss, mucocutaneous ulcerations, with a subsequent note of Histoplasma capsulatum (H. capsulatum) on bone marrow biopsy, suggested DH was the likely etiology of this subacute presentation. The differential diagnosis for this patient is broad, including infectious, noninfectious, and cardiac causes [4][5][6][7][8][9][10][11][12][13][14][15].…”

The Impact of a Vegan Diet on Many Aspects of Health: The Overlooked Side of Veganism

“…An optimal diet should be balanced, consisting of lean meat, nuts, fresh fruits and vegetables, and olive oil (Figure 1) [8,9]. A wholesome diet is essential in maintaining a healthy gut flora, which in turn is pivotal in avoiding inflammatory disorders [10][11][12][13]. The primary aim of this review will be to draw attention to the current literature associated with veganism, including the side effects of practicing a VD and long-term consequences for a variety of populations, including adults, adolescents, pregnant and lactating women, and the fetal outcomes of vegan mothers.…”