PD363 - MALNUTRITION IN SCLERODERMA: WHEN THE GUT FAILS, PARENTERAL SUPPORT BECOMES ESSENTIAL.

PD363

MALNUTRITION IN SCLERODERMA: WHEN THE GUT FAILS, PARENTERAL SUPPORT BECOMES ESSENTIAL.

A. Wierzbicka¹, K. Fernandez‐Garcia², T. Beek², R. Caraballo², R. Deringer², C. Silva², N. Lux², D. Mankowska-Wierzbicka^3,*, A. Ukleja²

¹Internal Medicine, ²Gastroenterology, Cleveland Clinic, Weston, United States, ³Department of Gastroenterology, Metabolic Diseases, Internal Medicine and Dietetics, Poznan, Poland

Rationale: Systemic sclerosis (SS) is a rare autoimmune disease frequently involving the gastrointestinal (GI) tract. Malnutrition significantly contributes to morbidity and mortality. However, standardized nutritional guidelines are lacking, and home parenteral nutrition (HPN) is often underutilized or initiated late. This study describes SS patients with severe malnutrition requiring parenteral support.

Methods: We performed a retrospective review of adult SS patients who initiated HPN at a tertiary academic center between 09/2022 and 03/2026. Data collected included demographics, disease characteristics, GI manifestations, prior nutritional interventions, PN type and duration, central venous access, complications, and outcomes.

Results: Six female SS patients (mean age 67.5 years, range 53–76) were identified (N=202). 5 had longstanding disease (>10 years), and 5 had interstitial lung disease. All exhibited extensive GI involvement: gastroesophageal reflux (n=6), dysphagia (n=6), chronic intestinal pseudo-obstruction (n=5), and gastroparesis (n=3). None received prior formal nutritional counseling or enteral nutrition before PN initiation. Mean PN duration was 23.9 months (range 0.25–65). Central access included PICCs (n=5) and tunneled catheters (n=2). 2 patients developed catheter-related bloodstream infections. Micronutrient deficiencies were common. 3 patients died.

Conclusion: This series highlights delayed recognition of malnutrition and lack of early nutritional intervention in SS. Profound GI dysmotility often precludes enteral feeding, making PN the only viable option. These findings underscore the need for earlier referral to nutrition support services and the establishment of evidence-based guidelines to address complex nutritional needs for SS patients. GI manifestations have been linked to nutritional decline and increased mortality in SS patients.

Disclosure of Interest: A. Wierzbicka Other: None, K. Fernandez‐Garcia Other: None, T. Beek Other: None, R. Caraballo Other: None, R. Deringer Other: None, C. Silva Other: None, N. Lux Other: None, D. Mankowska-Wierzbicka Other: none, A. Ukleja Other: None