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Systemic sclerosis and anorectal dysfunction: The Leeds experience.

Nikhil Suresh1,2, Ranjitha Karanth1,2, Ramsah Cheah2

  • 1Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.

Journal of Scleroderma and Related Disorders
|October 10, 2024
PubMed
Summary
This summary is machine-generated.

Systemic sclerosis causes internal anal sphincter atrophy, leading to faecal incontinence. This study found significantly lower sphincter thickness and resting pressures in patients with systemic sclerosis and faecal incontinence compared to controls.

Keywords:
Systemic sclerosisanorectumfaecal incontinenceinternal anal sphincter

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Area of Science:

  • Gastroenterology
  • Rheumatology
  • Autoimmune Diseases

Background:

  • Systemic sclerosis (SSc) is an autoimmune disease impacting multiple organs, frequently involving the gastrointestinal tract.
  • Anorectal dysfunction, particularly internal anal sphincter (IAS) atrophy, is a common complication in SSc patients.
  • Faecal incontinence (FI) in SSc is often attributed to IAS atrophy.

Purpose of the Study:

  • To evaluate the internal anal sphincter (IAS) in patients with SSc and FI.
  • To compare IAS characteristics between SSc patients with FI and a control group.
  • To investigate the relationship between SSc, IAS structure, and FI symptoms.

Main Methods:

  • Anorectal manometry and endoanal ultrasound were used to assess the IAS.
  • Seventeen patients with SSc and FI were compared to an age- and gender-matched control group.
  • Patient demographics, clinical presentation (faecal leakage, urgency), and rectal sensation were recorded.

Main Results:

  • Systemic sclerosis patients exhibited significantly lower mean IAS thickness compared to controls (p < 0.001).
  • Low basal sphincter pressures were observed in SSc patients with FI.
  • Rectal sensation was preserved, and external anal sphincter thickness did not differ between groups.

Conclusions:

  • Internal anal sphincter atrophy is a key factor in faecal incontinence associated with systemic sclerosis.
  • Reduced IAS thickness and resting pressures contribute to passive faecal leakage in SSc.
  • Further research is needed on the natural history, risk factors, and treatments for FI in SSc.