Fecal incontinence and scleroderma: Pathogenesis and unmet needs

Area of Science:

• Gastroenterology
• Rheumatology
• Immunology

Background:

• Scleroderma is a chronic autoimmune disease frequently impacting the gastrointestinal (GI) system.
• Faecal incontinence (FI) is a common complication in scleroderma patients with GI involvement, yet its impact on quality of life (QoL) and healthcare costs is poorly understood.
• Existing data on FI in scleroderma are limited by retrospective designs and small sample sizes.

Purpose of the Study:

• To review and synthesize current knowledge on anal sphincter involvement and faecal incontinence (FI) in scleroderma.
• To highlight the diagnostic findings and treatment outcomes for FI in this patient population.
• To identify gaps in research and suggest future directions for managing FI in scleroderma.

Main Methods:

• Literature review of studies investigating anal sphincter function and faecal incontinence in scleroderma patients.
• Analysis of data from case reports, case series, and retrospective studies.
• Examination of imaging findings, such as anorectal ultrasound, to assess internal anal sphincter morphology.

Main Results:

• Faecal incontinence (FI) affects up to 40% of scleroderma patients with GI involvement.
• Anorectal ultrasound imaging demonstrates direct involvement of the internal anal sphincter muscularis propria, showing thinning, atrophy, or scarring.
• Current treatment guidelines are primarily symptomatic, and surgical interventions have shown poor outcomes.

Conclusions:

• Faecal incontinence is an under-recognized and significant complication of scleroderma, impacting patient quality of life.
• Damage to the internal anal sphincter is a key factor contributing to FI in scleroderma.
• Sacral neuromodulation shows promise for a subset of patients, but further controlled studies are needed to confirm efficacy and prognostic impact.