Gastrointestinal Manifestations of Systemic Sclerosis

Abstract

In patients with systemic sclerosis (SSc), gastrointestinal (GI) tract involvement is almost universal. Any segment of the GI tract from mouth to anus can be involved, and GI symptoms are a frequent cause of morbidity. In severe cases, GI tract involvement can progress to the point of malnutrition requiring parenteral nutrition. GI tract involvement in SSc contributes to disease-related mortality although mostly as a co-morbidity rather than direct cause of death. The review is intended to help address challenges in the assessment and treatment of GI tract involvement in SSc.

Keywords: gastrointestinal; motility; scleroderma; systemic sclerosis.

Figure 1

Esophageal manometry images for a normal control patient (A) and a patient with systemic sclerosis (B) are shown. The y-axis shows the length measured in the esophagus, including the location of the upper esophageal sphincter (UES) and lower esophageal sphincter (LES). The x-axis shows the time of the recording that captured one swallow. In (A), the diagonal region with topographical color change shows a normal swallow with distal propagation of esophageal peristalsis with time and corresponding LES relaxation. In (B), esophageal peristalsis is notably absent from the distal two-thirds of the esophagus, and resting LES pressure is low.

Figure 2

Endoscopic images of the distal esophagus are shown from the same patient with systemic sclerosis depicting grade C esophagitis (A) and healed esophagitis (B) after several weeks of proton-pump inhibitor therapy.

Figure 3

Endoscopic images from a patient with systemic sclerosis depicting gastric antral vascular ectasia before (A) and after (B) argon plasma coagulation therapy.