Steatorrhoea in Progressive Systemic Sclerosis (Scleroderma)

Abstract

Only half the stomach was removed. The importance of ligating the vasa brevia to reduce the gastric acidity is emphasized.Only one patient (0.8%) developed an anastomotic ulcer.The incidence of the dumping syndrome was much lower than with the standard three-quarters gastrectomy.Bile vomiting occurred in 23% of the series, but was severe in only one woman.Iron-deficiency anaemia was present in 65% of the men.Loss of weight occurred in 92% of the patients. There was no correlation between the result of the operation and the amount of weight lost.We are grateful to Miss Turner, M.A., the senior almoner, without whose help and ingenuity it would have been impossible to trace many of the patients. We are also indebted to the general practitioners of Oxford who also went to great trouble in helping us to find the patients.

Progressive systemic sclerosis in the elderly

“…Patients with involvement of the small bowel may present with malabsorption (McBrian and Mummery, 1962) and this was suspected in the second patient because of her folate deficiency, but not confirmed on further investigation. Although involvement of the heart is frequent in systemic sclerosis, in case no.…”

Sclerodermatous involvement of the stomach and the small and large bowel.

“…In the majority of cases in which scleroderma involves the gastrointestinal tract, a history of Raynaud's phenomenon and some evidence of skin involvement precedes the visceral involvement and is of great help in suggesting the cause of the gastrointestinal symptoms. There have, however, been a number of case reports of bowel involvement in the presence of little or no skin involvement by scleroderma (Hale and Schatzki, 1944;Marshall, 1956;Sommerville, Bargen, and Pugh, 1959;Herrington, 1959;Crown, 1961;McBrien and Lockhart Mummery, 1962).…”

“…(Sonneveldt, van Leeuwen, and Blom, 1962). Various explanations have been put forward to explain the malabsorption in these patients but it now seems likely that a change of bowel flora, probably consequent upon stasis in the small bowel, is the most common cause (McBrien and Lockhart Mummery, 1962;Kahn, Jeffries, and Sleisenger, 1966;Salen, Goldstein, and Wirts, 1966;Cliff, Herber, and Demis, 1966). A striking response of diarrhoea and steatorrhoea to broad-spectrum antibiotic therapy was seen in several of our cases, although the involvement was not always so obvious if subsequent courses of treatment were given.…”

Gastrointestinal Involvement in Systemic Scleroderma

“…Our findings agree well with the fact th at m alabsorption is seldom present in scleroderma, and, when present, it is hardly or ever due to an epithelial defect. It is rather a secondary m alabsorption syndrome evoked by abnorm al bacterial growth in the intestinal lumen, as proposed by McBrien and Lockhart Mummery [8], who again refer this to intestinal stasis caused by the stiff, fibrous intestinal wall.…”

“…A bout 70 years ago it was established, th at the disease may involve the gastrointestinal tract, when dysphagia caused by oeso phageal lesions was described by Ehrmann [4], General agreement exists th a t the disease more often and more severely affects the oeso phagus than other parts of the alim entary tract [11]. However, within the last decade, reports have appeared on malabsorption syndromes associated with systemic scleroderma [2,[7][8][9][10], and on gastrointestinal scleroderma sim ulating intestinal obstruction due to fibrous infiltra tion of the muscular coat of the small and large bowel [1,6].The incidence of m alabsorption in systemic scleroderma is not known, bu t seems to be low [7]. Furtherm ore, there seems to be no relationship between the severity of skin lesions and the extent and clinical signs of gastrointestinal involvement.…”