Intestinal Involvement in Systemic Sclerosis: A Clinical Review.

Area of Science:

• Gastroenterology
• Rheumatology
• Internal Medicine

Background:

• Systemic sclerosis (SSc) is a chronic disease impacting microvasculature, immunity, and causing fibrosis.
• Intestinal involvement is common in SSc, leading to substantial patient morbidity and reduced quality of life.
• Pathogenesis involves vascular damage, nerve dysfunction, smooth muscle atrophy, and fibrosis, resulting in gut hypomotility.

Purpose of the Study:

• To review the pathogenesis, assessment, and management of intestinal manifestations in Systemic Sclerosis.
• To highlight the inadequacy of current management strategies for SSc-related gastrointestinal dysfunction.
• To emphasize the need for early immunomodulation and a multidisciplinary approach.

Main Methods:

• Literature review of pathogenesis, clinical manifestations, and treatment strategies for SSc intestinal involvement.
• Analysis of diagnostic approaches including screening for hypomotility, malnutrition, SIBO, and anorectal dysfunction.
• Evaluation of current therapeutic interventions for diarrhea, malabsorption, constipation, pseudo-obstruction, fecal incontinence, and pneumatosis intestinalis.

Main Results:

• Intestinal hypomotility in SSc leads to SIBO, malabsorption, malnutrition, and altered bowel habits.
• Common manifestations include diarrhea, constipation, pseudo-obstruction, pneumatosis intestinalis, and fecal incontinence.
• Existing treatments are often insufficient, with specific interventions for SIBO, malabsorption, and constipation showing limited success.

Conclusions:

• Intestinal manifestations significantly impact SSc patient quality of life and life expectancy.
• Early consideration of immunomodulation is crucial for managing intestinal SSc.
• Optimal management requires a collaborative, multidisciplinary approach involving gastroenterologists and rheumatologists.