Systemic sclerosis and the gut

Abstract

Gastrointestinal involvement (GI) is increasingly recognized as a major cause of both morbidity and mortality in systemic sclerosis (SSc). GI complications are common, second only to skin involvement, and affect up to 90% of patients. Although treatment modalities have changed little for upper gut symptoms such as GI reflux, there are emerging treatment modalities for the common lower gut symptoms (constipation and fecal incontinence), which will be reviewed. The important link between reflux and interstitial lung disease in SSc is also addressed. The aim of this review is to help the clinician understand and manage GI symptoms in SSc.

Systemic Sclerosis

“…Reduced frequency of the slow waves by the gastric pacemaker (bradygastria), which initiates contraction to crush food against a closed pylorus, combined with decreased muscle activity and increased compliance in the fundus, can result in significant dysfunction. 24 Assessment of delayed emptying is done with gastric emptying studies in nuclear medicine, but a motility capsule can also be used as well as gastric emptying breath test, antroduodenal manometry, and electrogastrography. 13 Treatment to increase gastric motility includes prokinetic drugs such as metoclopramide, domperidone, erythromycin, and cisapride.…”

“…13 Treatment to increase gastric motility includes prokinetic drugs such as metoclopramide, domperidone, erythromycin, and cisapride. 13,24,25 Metoclopramide, a central and peripheral dopamine receptor antagonist, has been found to augment antral, duodenal, and jejuna motor activity. 24 A dose of 10 to 15 mg 4 times a day is the maximum dose.…”

“…13,24,25 Metoclopramide, a central and peripheral dopamine receptor antagonist, has been found to augment antral, duodenal, and jejuna motor activity. 24 A dose of 10 to 15 mg 4 times a day is the maximum dose. However, concern about long-term use and extrapyramidal side effects limits its use.…”

Management of Gastrointestinal Involvement in Scleroderma

“…Gastrointestinal involvement occurs early in SSc and most patients (up to 90%) are affected [4-6]. In SSc, gastrointestinal disease is heterogeneous, clinically ranging from asymptomatic disease to significant dysmotility, and the time course may vary from indolent to rapidly progressive.…”

“…As with management of any chronic constipation, existent constipating medications should be stopped and structural causes should be excluded [4]. Lifestyle modifications should be advised – liberal ingestion of fluids and ensuring adequate (but not excessive) fiber intake.…”