Gut Disease in Systemic Sclerosis—New Approaches to Common Problems

Abstract

Purpose of review:The goal of this manuscript is to discuss the new diagnostic and potential treatment options for gut disease in systemic sclerosis (SSc). The concepts of quantification of gut perfusion and motility is reviewed. The risks of empiric therapeutics and challenges of studying the microbiome in SSc is discussed.Recent findings: There are diagnostics that can provide information on gut perfusion and function that are of value in SSc. Easily implemented diagnostic tests are critical to avoid complications of empiric therapy. The role of the microbiome and drugs that target dysmotility are areas of active research.

Preventing Malnutrition through Adequate Management of Gastrointestinal Dysmotility in Systemic Sclerosis Patients: A Literature Review

“…16 Many recent studies have also linked the alteration of gut flora composition in SSc, which plays an important role of nitric oxide (NO) regulation, to the manifestations of GI dysmotility. 17 The alternate proposed mechanism of GI dysmotility progression in SSc that has been widely accepted is that the condition originates from the autonomic dysfunction associated with neuropathy, which leads to atrophy of GI smooth muscle cells and hypomotility through impaired peristaltic movement. 9,10,18 The postulate is also supported by the finding of muscarinic acetylcholine receptor 3 (M3-R) antibody in SSc, an autoantibody produced from aberrant humoral response, which precipitates the irreversible structural changes in the neuromuscular junction of myenteric plexus, rendering the smooth muscle of GI tract unresponsive to external stimuli.…”

“…10 SSc patients with Raynaud's phenomenon often consumes calcium channel blocker (CCB) which could contribute to the persistence of GERD symptoms despite adequate therapy. 17 When GERD follows a refractory course and pharmacological management fails, endoscopic surgical procedures may be attempted. 4,10 Unfortunately, there has not been a consensus and standardized algorithms regarding the surgical management of GERD in special population in SSc.…”

“…10 Administration of some drugs which are associated with impairment of GI smooth muscle motility, such as opioid medication and PDE-5 inhibitor should also be promptly evaluated. 17 Later stages of gastroparesis are difficult to control with medications and enteral nutrition via percutaneous gastrostomy or jejunostomy might be the best option, especially when patients are in an increased risk of malnutrition with loss of 10% body weight in a period of 3-6 months. 32 Enteral nutrition can be started at 25 to 50 mL/hour with progressive increment of 10 to 25 mL/hour as tolerated.…”

Gastrointestinal manifestations of systemic sclerosis: An updated review

“…The pathophysiological mechanisms described previously will be reflected in the different GI manifestations of SSc, such as gastric dysrhythmias, elevated levels of vasoactive intestinal peptide, and decreased motilin in serum, by enterochromaffin cells and M cells in the stomach, SB, and colon, leading to a slow wave phenomenon with the consequent effect of intestinal transit[ 1 ]. In turn, this hypomotility phenomenon will lead to other phenomena, such as gastroesophageal reflux disease (GERD), gastroparesis, small intestinal bacterial overgrowth (SIBO), intestinal malabsorption, fecal incontinence and, in severe cases, chronic intestinal pseudo-obstruction (CIPO)[ 14 , 25 - 27 ].…”

The Collaborative National Quality and Efficacy Registry for Scleroderma: association of medication use on gastrointestinal tract symptoms in early disease and the importance of tobacco cessation

“…Gastrointestinal tract (GIT) symptoms are common in systemic sclerosis (SSc) (1). While there are established longitudinal markers for pulmonary and skin involvement in scleroderma including the modified Rodnan skin score (mRSS) and pulmonary function tests (PFT), serial assessment of the gastrointestinal tract is more challenging (2,3).…”