title: Review article: pathogenesis and clinical manifestations of gastrointestinal involvement in systemic sclerosis.
abstract: Gastrointestinal tract (GIT) involvement is a common cause of debilitating symptoms in patients with systemic sclerosis (SSc). There are no disease modifying therapies for this condition and the treatment remains symptomatic, largely owing to the lack of a clear understanding of its pathogenesis.
  
  
  
  To investigate novel aspects of the pathogenesis of gastrointestinal involvement in SSc. To summarise existing knowledge regarding the cardinal clinical gastrointestinal manifestations of SSc and its pathogenesis, emphasising recent investigations that may be valuable in identifying potentially novel therapeutic targets.
  
  
  
  Electronic (PubMed/Medline) and manual Google search.
  
  
  
  The GIT is the most common internal organ involved in SSc. Any part of the GIT from the mouth to the anus can be affected. There is substantial variability in clinical manifestations and disease course and symptoms are nonspecific and overlapping for a particular anatomical site. Gastrointestinal involvement can occur in the absence of cutaneous disease. Up to 8% of SSc patients develop severe GIT symptoms. This subset of patients display increased mortality with only 15% survival at 9 years. Dysmotiity of the GIT causes the majority of symptoms. Recent investigations have identified a novel mechanism in the pathogenesis of GIT dysmotility mediated by functional anti-muscarinic receptor autoantibodies.
  
  
  
  Despite extensive investigation, the pathogenesis of gastrointestinal involvement in systemic sclerosis remains elusive. Although treatment currently remains symptomatic, an improved understanding of novel pathogenic mechanisms may allow the development of potentially highly effective approaches including intravenous immunoglobulin and microRNA based therapeutic interventions.
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA.
authors.forename: S
authors.identifier: 0000-0003-4744-3848
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Singh
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Rattan
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: DiMarino
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Cohen
authors.affiliation: Jefferson Institute of Molecular Medicine and Scleroderma Center, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Jimenez
mesh_terms: D000818:Animals; D005355:Fibrosis; D041981:Gastrointestinal Tract / Q000473:pathology*; D006801:Humans; D007111:Immunity, Cellular; D056724:Immunity, Humoral; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000473:pathology*