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. 2019 Mar;5(1):11-19.
doi: 10.1007/s40674-019-00117-x. Epub 2019 Feb 7.

Gut disease in systemic sclerosis - new approaches to common problems

Jessica Zhu  1 , Tracy Frech  2
Affiliations

Gut disease in systemic sclerosis - new approaches to common problems

Jessica Zhu et al. Curr Treatm Opt Rheumatol. 2019 Mar.

Abstract

Purpose of review: The goal of this manuscript is to discuss the new diagnostic and potential treatment options for gut disease in systemic sclerosis (SSc). The concepts of quantification of gut perfusion and motility is reviewed. The risks of empiric therapeutics and challenges of studying the microbiome in SSc is discussed.

Recent findings: There are diagnostics that can provide information on gut perfusion and function that are of value in SSc. Easily implemented diagnostic tests are critical to avoid complications of empiric therapy. The role of the microbiome and drugs that target dysmotility are areas of active research.

Summary: SSc-related gastrointestinal tract involvement can be heterogeneous in clinical presentation and disease course. Noninvasive gastrointestinal measurement techniques that quantify neural communications with microvasculature in SSc can potentially guide the proper addition and discontinuation of therapeutics. The role of the microbiome and the role of nitric oxide on gut function are important areas of research for understanding gut dysfunction in SSc.

Keywords: Systemic sclerosis; gastrointestinal tract dysmotility; ischemia-reperfusion; microbiome; scleroderma.

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Conflict of interest statement

Conflict of Interest The authors declare that they have no conflict of interest.

Figures

Figure 1:
Figure 1:
Automated capture and analysis of sublingual microvasculature. Sidestream dark field imagery captures video recordings of the sublingual microvasculature. In each recording, the automated analysis system divides microvessels (red) into 10 μm perfused (green) or non-perfused (yellow) microvessel segments. Subsequently, markers of microvascular perfusion and glycocalyx penetrability are assessed in perfused microvessel segments. Adapted from Figure 1 in Machin DR, Gates PE, Vink H, Frech TM, Donato AJ. Automated Measurement of Microvascular Function Reveals Dysfunction in Systemic Sclerosis: A Cross-sectional Study. J Rheumatol. 2017 with permission from The Journal of Rheumatology.
Figure 2:
Figure 2:
Computational Molecular Phenotyping of Esophageal Biopsies: Three systemic sclerosis (SSc) and two Healthy Control (HC) were age-matched and analyzed for molecular signatures.
See this image and copyright information in PMC

References

    1. Gyger G, Baron M. Gastrointestinal manifestations of scleroderma: recent progress in evaluation, pathogenesis, and management. Curr Rheumatol Rep. 2012;14(1):22–9. - PubMed

    1. Poudel DR, Jayakumar D, Danve A, Sehra ST, Derk CT. Determinants of mortality in systemic sclerosis: a focused review. Rheumatol Int. 2018;38(10):1847–58.

      • The review discusses the newer focus of gastrointestinal tract disease on mortality in the international systemic sclerosis research community

    1. Poudel DR, Derk CT. Mortality and survival in systemic sclerosis: a review of recent literature. Curr Opin Rheumatol. 2018;30(6):588–93. - PubMed

    1. Eldoma M, Pope J. The contemporary management of systemic sclerosis. Expert Rev Clin Immunol. 2018;14(7):573–82.

      • This contemporary management article highlights the importance of the individual patient phenotype.

    1. Bae S, Allanore Y, Furst DE, Bodukam V, Coustet B, Morgaceva O, et al. Associations between a scleroderma-specific gastrointestinal instrument and objective tests of upper gastrointestinal involvements in systemic sclerosis. Clin Exp Rheumatol. 2013;31(2 Suppl 76):57–63. - PubMed

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