Clinical and upper gastrointestinal motility features in systemic sclerosis and related disorders

Weston, Shiobhan R.

doi:10.1016/s0002-9270(98)00215-9

Cited by 53 publications

(78 citation statements)

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“…Since the initial description of an association between BE and SSc by Cameron and Payne in 1978 (15), numerous case reports (16-28) and 3 retrospective series (29)(30)(31) (Table 3) have been published. In the earliest retrospective series, the prevalence of BE was estimated to be 37% among patients who were assessed by endoscopy following reports of clinical gastrointestinal symptoms (30), and 16% among patients referred to a gastroenterology department (31). SSc patients who undergo endoscopy because of digestive symptoms may represent the subgroup with the most severe esophageal involvement, thus increasing the prevalence of BE.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Barrett's esophagus in systemic sclerosis

Wipff¹,

Allanore²,

Soussi³

et al. 2005

Arthritis & Rheumatism

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Objective. The esophagus is the most commonly affected gastrointestinal area in systemic sclerosis (SSc). Patients with SSc frequently develop gastroesophageal reflux, esophageal injury, and sometimes, intestinal metaplasia, or Barrett's esophagus (BE), which may increase the risk of esophageal adenocarcinoma. This study sought to determine the prevalence of BE and esophageal adenocarcinoma in a cohort of SSc patients.Methods. One hundred ten SSc patients who were receiving long-term treatment with proton-pump inhibitors (PPIs) were assessed systematically by esophageal manometry and endoscopy. Esophageal biopsies were performed when macroscopic abnormalities were detected, and BE was diagnosed histologically.Results. Among the 110 patients, 14 had BE (12.7%). None of the patients with BE had adenocarcinoma, but 3 of the 14 patients (21%) had dysplasia on esophageal biopsy. Similar proportions of patients with and without BE had abnormal peristalsis and decreased lower esophageal sphincter pressure. No association between BE and other disease characteristics was demonstrated.Conclusion. In this study, 12.7% of SSc patients who had been treated with PPIs for long periods had BE, similar to the prevalence in patients with gastroesophageal reflux disease. Although none of the patients had esophageal adenocarcinoma, patients with BE should be followed up closely, particularly patients with dysplasic BE. Long-term prospective studies are warranted to determine the phenotype of SSc patients at high risk of developing dysplasia or esophageal adenocarcinoma.

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Section: Discussionmentioning

confidence: 99%

Prevalence of Barrett's esophagus in systemic sclerosis

Wipff¹,

Allanore²,

Soussi³

et al. 2005

Arthritis & Rheumatism

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“…On histological examination, smooth muscle atrophy and fibrosis causing motor activity abnormalities in two-thirds of the distal esophagus are often determined (4). Motility studies have shown that the amplitude of peristaltic contractions decreases or that there is no peristaltic contraction in this region (5)(6)(7). Abnormal peristalsis and decreased lower esophageal sphincter (LES) pressure reduce acid clearance and prolong the contact of acid with the mucosa (8).…”

Section: Systemic Sclerosismentioning

confidence: 99%

“…As a result, GERD develops in patients with scleroderma. In many cross-sectional studies using different methodologies, the prevalence of GERD has been reported to be at rates of up to 70% (9)(10)(11)(12)(13)(14)(15). (18), GERD prevalence was found to be 40.7%.…”

Section: Systemic Sclerosismentioning

confidence: 99%

Which diseases are risk factors for developing gastroesophageal reflux disease?

Akyüz

Soyer²

2017

Turk J Gastroenterol

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Gastroesophageal reflux disease (GERD) is known to present with various extraesophageal symptoms and complications. In contrast, several diseases affecting the motility of the esophagus and some approaches that alter the upper gastrointestinal tract anatomy may result in GERD. Certain diseases and conditions often mentioned with GERD will be briefly discussed in this section. Systemic SclerosisEsophageal motility is impaired in 70-90% of patients with systemic sclerosis (1-3). On histological examination, smooth muscle atrophy and fibrosis causing motor activity abnormalities in two-thirds of the distal esophagus are often determined (4). Motility studies have shown that the amplitude of peristaltic contractions decreases or that there is no peristaltic contraction in this region (5-7). Abnormal peristalsis and decreased lower esophageal sphincter (LES) pressure reduce acid clearance and prolong the contact of acid with the mucosa (8). As a result, GERD develops in patients with scleroderma. In many cross-sectional studies using different methodologies, the prevalence of GERD has been reported to be at rates of up to 70% (9-15). Diabetes MellitusFurthermore, various factors showing tendency to GERD were identified in diabetes mellitus. Among these,• Reduced salivary secretion associated with diabetic neuropathy, • Delayed gastric emptying, • Decreased acid clearance due to reduced motor activity of the esophagus/stomach related motor/autonomic neuropathy, • Increased sensory thresholds associated with sensory nerve damage of the esophagus, • Acid regurgitation caused by the increased frequency of transient LES relaxations related to neuropathy, CholecystectomyThe reservoir function of the gallbladder disappears after cholecystectomy, and bile flow becomes continuous (20,21). Qualitative changes may appear at the levels of gastrointestinal hormones (22,23). Consequently, alterations in the qualitative bile content and more frequent transient LES relaxation may occur (24). Moreover, it was thought that reflux symptoms in these patients worsen with increased biliary symptoms after cholecystectomy due to a high-fat diet intake and weight gain. Alterations in the motility of the upper gastrointestinal tract and delayed stomach emptying caused by duodenal adhesions may also contribute to GERD (25). There was no significant increase in reflux after cholecystectomy in the limited number of studies based on these data. Uyanıkoğlu et al. (26) used the impedance method and reported increased reflux after surgery and that the pH was <4% higher than that before surgery; however, it was similar to the control group. In another study, Lin et al. (27) compared patients with hernia surgery and cholecystectomy. Reduction in the reflux symptom score was 35% in patients, while it was 39% in controls (p=0.11). Sleeve GastrectomyMechanisms that may induce increased GERD in patients with GERD with sleeve gastrectomy include hypotensive LES (28), blunting of the angle of His (29), decreased gastric compliance (30), delayed gastric em...

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“…Oko 90% bolesnika ima poremećaj gastrointestinalnog trakta (18)(19)(20). Plućna hipertenzija, pleuritis i intersticijalna fibroza su manifestacije zahvaćenosti pluća (21).…”

Section: Ključne Rečiunclassified

Presentation of pain in patients suffering from systemic sclerosis

Jankovic¹

2016

Med podmladak

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Introduction: Systemic sclerosis (SSc) is a chronic autoimmune disease with very heterogeneous clinical manifestations. There are not many studies which directly research the pain experienced by patients with SSc. Aim: Evaluation of pain in patients with verified systemic sclerosis; making comparison in the two subsets of SSc (diffuse and limited) and in the anti-centromere antibodies (ACA) and anti-topoisomerase-I antibodies (ATA) detected in patients. Material and methods: The study group included 42 patients with SSc. The research was conducted at the Institute of Rheumatology in Belgrade. Each patient was asked to complete the questionnaire, which included the questions about frequency, location and intensity of the pain. Two statistical methodologies were used in the data analysis: descriptive and analytical statistics. Results: Most of the patients (93%) confirmed they had some kind of pain . Arthralgia was the most common pain symptom (78,6%), 29 (69%) suffered from pain during Raynaud phenomenon, the back pain was found in 20 (47,6%), a headache in 13 (31%), the chest pain in 10 (23,8%), odynophagia in 9 (21,4%) and in 8 (19%) patients painful digital ulcers. The pain from digital ulcers was rated as the most intensive with the average value of 8,5/10. The patients with diffuse subset of SSc had a higher average intensity score of arthralgia (7,6), compared to those with limited SSc (5,5). The statistically significant difference in the frequency and intensity of the pain in the patients with anti-topoisomerase-I antibodies and the patients with anti-centromere antibodies was not found. Conclusion: Most of the patients suffer from some kind of pain. The most common pain was arthralgia, and the most intensive one was from digital ulcers, although it was the rarest. The pain frequency and intensity were not significantly different in patients with anti-topoisomerase-I and anti-centromere antibodies. There was a statisticaly significant difference in the average value of arthralgia intensity, between the patients with diffuse and the patients with limited SSc.

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Clinical and upper gastrointestinal motility features in systemic sclerosis and related disorders

Abstract: In patients with GI symptoms associated with systemic sclerosis and related disorders, the amplitude and frequency of intestinal contractions are typically <10 mm Hg and <2/min. Antral amplitude is low (<40 mm Hg) when antral hypomotility is observed.

Cited by 53 publications

References 0 publications

Prevalence of Barrett's esophagus in systemic sclerosis

Prevalence of Barrett's esophagus in systemic sclerosis

Which diseases are risk factors for developing gastroesophageal reflux disease?

Presentation of pain in patients suffering from systemic sclerosis

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