title: Internal anal sphincter atrophy in patients with systemic sclerosis.
abstract: OBJECTIVE
  SSc is a connective tissue, multisystem disorder of unknown aetiology. The gastrointestinal tract (GIT) is affected in up to 90% of patients. The exact pathophysiology of GIT involvement is not known, but it is related to both neurogenic and myogenic abnormalities as well as possible vascular and ischaemic changes. Thinning of the internal anal sphincter (IAS) has been demonstrated in SSc with faecal incontinence. We aimed to investigate anal sphincter structure in patients with SSc.
  
  
  METHODS
  Forty-four SSc patients [24 symptomatic (Sx) and 20 asymptomatic (ASx)] and 20 incontinent controls (ICs) were studied. Patients underwent anorectal manometry and endoanal US.
  
  
  RESULTS
  In the ICs, external anal sphincter defects were more common, but the IAS was less atrophic, evident by both atrophy scores and IAS thickness. There was no significant difference in atrophy scores [Sx: 2 (1.5-3) vs ASx: 2 (1-2)] or IAS thickness [Sx: 1.85 (1.5-2.3) vs ASx: 1.8 (1.7-2.25)] between the Sx and ASx SSc patients.
  
  
  CONCLUSIONS
  Patients with SSc (both Sx and ASx) have thin and atrophic IAS, suggesting that IAS atrophy develops even in ASx patients and this may be amenable to treatment with sacral neuromodulation.
authors.affiliation: GI Physiology Unit, UniversityCollege Hospital, London, UK. norathoua@hotmail.com
authors.forename: Nora M
authors.initials: NM
authors.lastname: Thoua
authors.forename: Alexis
authors.initials: A
authors.lastname: Schizas
authors.forename: Alastair
authors.initials: A
authors.lastname: Forbes
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Denton
authors.forename: Anton V
authors.initials: AV
authors.lastname: Emmanuel
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000473:pathology*; D016022:Case-Control Studies; D019160:Endosonography / Q000379:methods; D005242:Fecal Incontinence / Q000150:complications; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000209:etiology / Q000473:pathology; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D012595:Scleroderma, Systemic / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D011795:Surveys and Questionnaires