title: Gastrointestinal manifestation of systemic sclerosis--thickening of the upper gastrointestinal wall detected by endoscopic ultrasound is a valid sign.
abstract: OBJECTIVE
  Gastrointestinal (GI) tract involvement has been observed in the majority of patients with SSc. This has been attributed to an accumulation of extracellular matrix within the GI walls. We visualized the walls of the oesophagus, stomach and duodenum with its layers and measured the thickness in SSc patients and control patients utilizing endoscopic ultrasound (EUS).
  
  
  METHODS
  Twenty-five SSc patients and 25 controls were evaluated. In addition to analysis of clinical symptoms, endoscopy and EUS (20-MHz miniprobe) were performed. The thickness of the complete wall was measured, and the mucosa, submucosa and muscularis were evaluated separately.
  
  
  RESULTS
  Clinical symptoms of SSc patients were dysphagia (14/25) and heartburn (19/25). Endoscopic findings were hiatal hernia (16/25), oesophagitis (6/25), amotility (19/25) and a dehiscent pylorus (15/25). In comparison with controls, SSc patients had significantly thicker oesophageal [SSc 1.619 (0.454) mm, control 1.392 (0.333) mm; P = 0.025], antral [SSc 1.876 (0.635) mm, control 1.599 (0.291) mm; P = 0.029] and duodenal [SSc 1.730 (0.522) mm, control 1.525 (0.222) mm; P = 0.039] walls. Predominantly, submucosa and muscularis were significantly thicker in SSc patients. The presence of dysphagia or amotility was significantly associated with the thickening of the GI walls.
  
  
  CONCLUSIONS
  The EUS revealed a significant thickening of the walls of the upper GI tract in SSc patients. Predominantly, the submucosa and muscularis are enlarged. These results strengthen the hypothesis that increased matrix deposition is an important aspect in the pathogenesis of GI involvement in SSc.
authors.affiliation: Department of Internal Medicine I, University Medical Center Regensburg, 93042 Regensburg, Germany. ina.zuber@gmx.de
authors.forename: Ina
authors.initials: I
authors.lastname: Zuber-Jerger
authors.forename: Adelheid
authors.initials: A
authors.lastname: Müller
authors.forename: Frank
authors.initials: F
authors.lastname: Kullmann
authors.forename: Cornelia M
authors.initials: CM
authors.lastname: Gelbmann
authors.forename: Esther
authors.initials: E
authors.lastname: Endlicher
authors.forename: Ulf
authors.initials: U
authors.lastname: Müller-Ladner
authors.forename: Martin
authors.initials: M
authors.lastname: Fleck
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004378:Duodenal Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D019160:Endosonography / Q000379:methods; D004935:Esophageal Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D005260:Female; D005767:Gastrointestinal Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012595:Scleroderma, Systemic / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D013272:Stomach Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D041742:Upper Gastrointestinal Tract / Q000000981:diagnostic imaging / Q000473:pathology*