Gastrointestinal manifestations of progressive systemic sclerosis.
Management of patients with progressive systemic sclerosis requires a thorough gastroenterological examination and a profound knowledge of possible gastrointestinal manifestations of the disease. The esophagus is the gastrointestinal segment most often involved. Smooth muscle atrophy leads to a loss of esophageal peristalsis, a defect of the lower esophageal sphincter, and gastric hypomotility, thus predisposing to severe reflux esophagitis. A rational diagnostic approach includes standard manometry and endoscopy. The prevention of strictures is the main aim of therapeutic efforts that may consist of lifestyle changes, prokinetic drugs, long-term application of proton pump inhibitors, and, if inevitable, surgical intervention. Involvement of the small intestine and colon is less common but may lead to life-threatening complications like chronic pseudoobstruction or pneumatosis cystoides intestinalis. The main therapeutic options consist of antibiotics for bacterial overgrowth and nutritional supplementation. Recently, a preliminary study with octreotide yielded promising results. Anorectal dysfunction can lead to fecal incontinence or rectal prolapse.
Lock
G
G
University of Regensburg, Department of Internal Medicine I, Germany.
Holstege
A
A
Lang
B
B
Schölmerich
J
J
D004064:Digestive System / Q000503:physiopathology*; D004066:Digestive System Diseases / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D012595:Scleroderma, Systemic / Q000150:complications / Q000503:physiopathology*