Early endoscopy in systemic sclerosis without gastrointestinal symptoms

Abstract

Investigation into the upper GI-tract of patients suffering from systemic sclerosis [SSc] and mixed connective tissue disease [MCTD] without symptoms of GI-tract involvement early in the course of the disease to diagnose inflammatory and motility disorders. We retrospectively analysed patients with SSc and MCTD who underwent oesophago-gastro-duodenoscopy [OGD] within a year of the first diagnosis. Patients with a Rodnan skin score above 5, proton pump inhibitors and treatment regimes potentially harmful to the mucosa of the upper GI-tract were excluded. Mucosal damage of the oesophagus was classified according to the Los Angeles Classification. Oesophageal dysmotility was assessed during OGD and confirmed by video cineradiography. A total of thirteen patients with SSc and six with MCTD fulfilled the inclusion criteria. OGD revealed reflux-oesophagitis in 77%, dysmotility of the distal oesophagus in 85%, gastritis in 92% [31% erosive gastritis] and Helicobacter pylori positivity in 38% of our patients suffering from SSc. Patients with MCTD showed features of reflux-oesophagitis, dysmotility of the distal oesophagus, gastritis and dysmotility of the stomach in 0.6%. In all thirteen patients with SSc, significant pathology of the upper GI-tract was found. The results of this study might indicate that OGD should be performed early in patients diagnosed with SSc, even if they do not report typical symptoms. An early diagnose of GI involvement might be followed by an effective therapy and therefore subsequently may improve the prognosis.

Gastrointestinal Manifestations of Scleroderma: Recent Progress in Evaluation, Pathogenesis, and Management

“…Many of the patients are asymptomatic. In a retrospective analysis of early SSc and mixed connective tissue disease, patients without clinical esophageal symptoms underwent esophagogastroduodenoscopy (EGD) [25]. EGD revealed reflux esophagitis in 77% of patients, dysmotility of the distal esophagus in 85%, gastritis in 92% (31% erosive gastritis), and Helicobacter pylori positivity in 38% [25].…”

Systemic Sclerosis

“…Investigations with esophagealgastroduodenoscopy (EGD) in 13 patients with early SSc without GI tract symptoms found reflux esophagitis in 77% of patients, dysmotility of the distal esophagus in 85%, gastritis in 95% (31% erosive gastritis) and Helicobacter pylori in 38% of the patients. 10 Some pathologic conditions of the upper GI tract were found in all the patients.…”

Gastroesophageal Reflux Disease-Related Disorders of Systemic Sclerosis Based on the Analysis of 66 Patients

“…It is clinically important that esophageal disorders occur in the early stage of SSc [7,8]. The median of disease duration in our study subjects was only 1 year (average 5.1 ± 8.1 years), indicating that GERD-related disorders occur in the very early stage of SSc disease.…”

“…For organic disorders involving the SSc patient's esophagus, the prevalence of RE was reported to be up to 30-70% [7,8] and that of Barrett's esophagus was reported to be 12.7% [9]. Such high prevalence is probably due to abnormal motility characterized by the loss of peristalsis in distal esophagus and lower esophageal sphincter pressure [10,11].…”