Gastrointestinal symptoms and motility disorders in patients with systemic scleroderma

Abstract

Background: Studies on gastrointestinal symptoms, dysfunctions, and neurological disorders in systemic scleroderma are lacking so far.

Methods: Thirty-eight scleroderma patients (34 limited, 4 diffuse), 60 healthy controls and 68 dyspeptic controls were scored for upper and lower gastrointestinal symptoms (dyspepsia, bowel habits), gastric and gallbladder emptying to liquid meal (functional ultrasonography) and small bowel transit (H2-breath test). Autonomic nerve function was assessed by cardiovascular tests.

Results: The score for dyspepsia (mainly gastric fullness) was greater in scleroderma patients than healthy controls, but lower than dyspeptic controls who had multiple symptoms, instead. Scleroderma patients with dyspepsia had a longer disease duration. Fasting antral area and postprandial antral dilatation were smaller in scleroderma patients than dyspeptic and healthy controls. Gastric emptying was delayed in both scleroderma patients (particularly in those with abnormal dyspeptic score) and dyspeptic controls, who also showed a larger residual area. Despite gallbladder fasting and postprandial volumes were comparable across the three groups, gallbladder refilling appeared delayed in dyspeptic controls and mainly dependent on delayed gastric emptying in scleroderma. Small intestinal transit was also delayed in 74% of scleroderma and 66% of dyspeptic controls. Bowel habits were similar among the three groups. Autonomic neuropathy was not associated with dyspepsia, gastric and gallbladder motility and small intestinal transit.

Conclusion: In scleroderma patients dyspepsia (mainly gastric fullness), restricted distension of the gastric antrum and diffuse gastrointestinal dysmotility are frequent features. These defects are independent from the occurrence of autonomic neuropathy.

Figure 1

Time-course of Visual Analogue Scale (VAS) for epigastric fullness in the fasting state (Time 0) and at regular intervals postprandially during the motility tests in SSc patients (white circles), healthy controls (black circles) and in dyspeptic controls (white squares) at each time point. Vertical lines indicate SE values. In the inset: Area Under Curve *P < 0.01 vs healthy controls; °P < 0.01 vs both SSc patients and healthy controls (ANOVA followed by Fisher's LSD test).

Figure 2

Time-course of percentage antral area as index of gastric emptying (top panel) and of gallbladder volume (bottom panel) in SSc patients (white circles), healthy controls (black circles) and in dyspeptic controls (white squares) after ingestion of the standard liquid meal. Symbols indicate mean values while vertical lines indicate SE values at each time-point. Top panel (gastric emptying): *P < 0.01 SSc patients and dyspeptic controls vs healthy controls from time 10 minutes to time 120 minutes, and SSc patients vs dyspeptic controls from time 40 minutes to time 120 minutes (ANOVA followed by Fisher's LSD test). Bottom panel (gallbladder emptying): *P < 0.05 dyspeptic vs healthy controls from time 60 minutes to time 120 minutes, and SSc patients vs healthy controls from time 90 minutes to time 120 minutes (ANOVA followed by Fisher's LSD test).

Figure 3

Top panelTime-course of gallbladder volume in SSc patients with normal (black circles, N = 18) or abnormal (white circles, N = 17) gastric emptying, after ingestion of the standard liquid meal. *P < 0.05 vs patients with abnormal gastric emptying (Mann-Whitney U-test). Bottom panel: Time-course of gallbladder volume in dyspeptic controls with normal (black squares, N = 29) or abnormal (white squares, N = 39) gastric emptying, after ingestion of the standard liquid meal. P = NS at each time point (Mann-Whitney U-test).