Internal anal sphincter atrophy in patients with systemic sclerosis

Area of Science:

• Gastroenterology
• Rheumatology
• Anorectal Physiology

Background:

• Systemic sclerosis (SSc) is a multisystem connective tissue disorder impacting up to 90% of patients via gastrointestinal tract (GIT) dysfunction.
• Pathophysiology of GIT involvement in SSc involves neurogenic, myogenic, vascular, and ischemic factors.
• Internal anal sphincter (IAS) thinning is observed in SSc patients with fecal incontinence.

Purpose of the Study:

• To investigate the structural integrity of the anal sphincter in patients with Systemic Sclerosis (SSc).
• To compare anal sphincter structure between symptomatic (Sx) and asymptomatic (ASx) SSc patients and incontinent controls (ICs).

Main Methods:

• Anorectal manometry and endoanal ultrasound were performed on 44 SSc patients (24 Sx, 20 ASx) and 20 ICs.
• Analysis included atrophy scores and IAS thickness measurements.

Main Results:

• Incontinent controls (ICs) exhibited more external anal sphincter defects but less IAS atrophy compared to SSc patients.
• No significant differences in atrophy scores or IAS thickness were found between symptomatic (Sx) and asymptomatic (ASx) SSc patients.
• SSc patients, regardless of symptoms, demonstrated thin and atrophic IAS.

Conclusions:

• Systemic sclerosis (SSc) patients exhibit internal anal sphincter (IAS) atrophy, even in the absence of overt symptoms.
• IAS atrophy in SSc patients suggests a potential therapeutic target for interventions like sacral neuromodulation.