Multimodality imaging of the gastrointestinal manifestations of scleroderma

Abstract

Scleroderma is a complex multisystem connective tissue disorder. Early visceral disease, such as gastrointestinal (GI) involvement, is associated with significant morbidity and a poorer prognosis. Prompt diagnosis is crucial to allow disease modifying therapies be initiated early in the course of the disease. The primary underlying pathophysiology in the GI tract is dysmotility, muscular atrophy, and fibrosis, and this is reflected in the imaging features. In this paper, we demonstrate the imaging appearances of involvement of the GI tract and describe the use of advanced imaging with magnetic resonance enterography (MRE). A multimodal imaging approach is required to identify both characteristic features of scleroderma and potential complications. Traditional fluoroscopic contrast (barium) studies are still commonly performed for assessment of the oesophagus. More recent advances in cross-sectional imaging allow for thorough three-dimensional assessment of the entire GI tract. MRE is particularly useful for small bowel evaluation while also allowing "pseudodynamic" functional imaging and concomitant assessment of the other abdominal viscera and structures.

Autoimmune Dysphagia Related to Rheumatologic Disorders: A Focused Review on Diagnosis and Treatment

“…In contrast, others suggest a higher incidence and severity of esophageal dysmotility with diffuse scleroderma and substantial skin involvement [ 34 , 37 ]. The antibodies anti-Scl 70 and anti-RNPC-3, but not anti-centromere, have been associated with dysmotility [ 38 ]. About 35% of people with dysphagia also have gastroesophageal reflux, although only around 4% of the population with SSc experiences dysphagia [ 39 ].…”

“…For example, in SS, alleviating xerostomia (dry mouth) is key, which can be achieved through artificial saliva or secretagogues to boost salivary flow [ 43 ]. Acid suppression therapy is beneficial when peptic lesions contribute to dysphagia such as in scleroderma or lupus [ 38 ]. Treatment of underlying malignancy alleviates dysphagia in DM [ 30 ].…”

Manifestations of the gastrointestinal tract in systemic rheumatic diseases: A narrative review

“…Поэтому при подозрении на развитие серьезных осложнений со стороны Научно-практическая ревматология. 2022;60(6):578-586 пищеварительной системы следует использовать объективные методы визуализации, такие как эндоскопия (ЭГДС, ФКС, ВКЭ), компьютерная томография (КТ), рентгенография и ультразвуковое исследование (УЗИ) [2,[50][51][52][53][54][55].…”

“…Рентгенологические методы с использованием контраста позволяют выявлять нарушения моторики, проходимости, участки патологического расширения и сужения ЖКТ и представляют значительную ценность для подтверждения функциональных проблем (в частности дисфагии, халазии кардии, декомпенсации стриктур пищевода, привратника и кишечника и др.) [2,53,54].…”