GASTROINTESTINAL MANIFESTATIONS OF SCLERODERMA
Section snippets
PATHOPHYSIOLOGY
Overproduction of collagen, increased humoral immune activity, and abnormal cellular immune function all contribute to the development of scleroderma in all of the organ systems. The pathologic changes seen in scleroderma are similar throughout the gastrointestinal tract. The integrity of epithelial cell morphology and villus structures, where present, is maintained except in circumstances in which they are affected by secondary processes, such as gastroesophageal reflux or bacterial overgrowth.
SYMPTOMS AND MANIFESTATIONS BY ORGAN SYSTEM
Table 2 summarizes the gastrointestinal symptoms found in patients with scleroderma. Table 3 lists the diagnostic procedures and indications for these procedures for patients with gastrointestinal symptoms associated with scleroderma. The following is a detailed analysis of symptoms, with diagnostic and treatment strategies by organ system.
SUMMARY
Gastrointestinal involvement is commonly found in scleroderma. Gastrointestinal symptoms may be the presenting symptoms for the diagnosis and may precede the actual diagnosis by months to years. The esophagus is the most frequently affected, but functional problems of the anorectum, small bowel, colon, and stomach may occur. The pathophysiologic mechanism appears to be one of smooth muscle atrophy and, to a lesser degree, fibrosis. These changes result in gastrointestinal motility disturbances
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2021, Best Practice and Research: Clinical RheumatologyCitation Excerpt :Notwithstanding, the aetiology for FI is believed to be multifactorial, going beyond the involvement of the muscularis propria of the anal sphincter. Other factors involved may include small bowel bacterial overgrowth causing diarrhoea and chronic inflammation around the sphincter complex [6,8,13]. In the context of multifactorial pathogenesis of GI dysmotility, Generini et al., in 1999 postulated that autonomic nerve dysfunction is the principal driving force associated with the microvascular and GI symptoms in patients with scleroderma [12].
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