Delayed gastric emptying identifies a high-risk clinical subgroup in patients with systemic sclerosis

Abstract Objectives To determine the prevalence of objectively defined gastric dysmotility in systemic sclerosis (SSc) and to evaluate its associations with SSc clinical and immunological features and adverse outcomes (SSc-related death and/or lung transplantation). Methods We conducted a retrospective cohort study. All participants underwent a standardized 4-h solid gastric emptying scintigraphy. Gastric dysmotility was defined as ≥ 20% gastric retention at 4-h. We examined associations between gastric dysmotility and demographic, clinical, and immunologic characteristics of SSc, as well as relevant clinical outcomes. Results Ninety-four patients were included (mean age 48 ± 12 years; 81% female). Gastric dysmotility was identified in 33 patients (35%). Patients with gastric dysmotility had a higher prevalence of interstitial lung disease (63.6%.vs.30.3%, p= 0.033) and absent esophageal contractility (75.8%.vs.45.9%, p 0.001) compared with those without. Gastric dysmotility was less frequent in patients with anti-centromere antibodies (27.3%.vs.55.0%, p= 0.009) but more common in those with anti-U1RNP antibodies (15.6%.vs.1.7%, p= 0.011). During follow-up (mean duration 2.8 ± 1.7 years; 260 person-years), 16 patients (17.0%) experienced the composite end point of SSc-related death and/or lung transplantation. In unadjusted Cox regression, gastric dysmotility was strongly associated with adverse outcomes (HR = 6.47, 95%CI: 2.09–20.10, p= 0.001), which remained significant after adjustment for confounders (HR = 4.23, 95%CI: 1.25–14.33, p= 0.020). Conclusions In SSc, we have confirmed that gastric dysmotility is associated with a distinct clinical and serological phenotype and that it independently predicts serious adverse outcomes. These findings underscore the importance of objective assessment of gastric function and its potential role in risk stratification.