title: Intravenous immunogobulin therapy for severe gastrointestinal involvement in systemic sclerosis.
abstract: OBJECTIVE
  Gastrointestinal (GI) disease is one of the major causes of morbidity in patients with systemic sclerosis (SSc). The most common manifestation of GI disease is oesophageal involvement affecting 70-90% of patients. Severe GI disease is uncommon, but results in symptoms such as early satiety, pseudo-obstruction, weight loss and malnutrition. The pathogenesis is relatively poorly understood, and management focuses on symptomatic control rather than immunomodulation.
  
  
  METHODS
  We describe two cases of patients with SSc myositis overlap syndrome with severe GI involvement who demonstrated improvements in swallowing, early satiety and diarrhoea following the administration of intravenous immunoglobulin (IVIg).
  
  
  RESULTS
  Clinical data related to the two cases were collected by review of medical records.
  
  
  CONCLUSIONS
  GI complications range from mild symptoms to debilitating and life threatening. We propose that IVIg may have an immunomodulatory effect in a subset of patients with SSc myositis overlap syndrome.
authors: Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, Royal Free Hospital Campus, University College London, UK.
authors: Kristina E N
authors: KE
authors: Clark
authors: Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, Royal Free Hospital Campus, University College London, UK.
authors: Oseme
authors: O
authors: Etomi
authors: Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, Royal Free Hospital Campus, University College London, UK. c.denton@ucl.ac.uk.
authors: Christopher P
authors: CP
authors: Denton
authors: Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, Royal Free Hospital Campus, University College London, UK.
authors: Voon H
authors: VH
authors: Ong
authors: Centre for Gastroenterology, Royal Free NHS Foundation Trust, London, UK.
authors: Charles D
authors: CD
authors: Murray
mesh_terms: D000328:Adult; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009220:Myositis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D020127:Recovery of Function; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors