Key Points
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Gut involvement in systemic sclerosis occurs more commonly in the diffuse than the limited cutaneous variant
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Oesophageal involvement is the most common gastrointestinal manifestation of systemic sclerosis, with severe reflux disease and dysphagia as the main presentations
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When treating small intestinal bacterial overgrowth in patients with systemic sclerosis, effectiveness of treatment and decisions about cyclical courses of antibiotic are best assessed by symptoms rather than breath testing
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Malnutrition in patients with systemic sclerosis is associated with more aggressive disease progression, and the risk of developing malnutrition is related to both gut and extraintestinal factors
Abstract
Systemic sclerosis is a multisystem autoimmune disorder that involves the gastrointestinal tract in more than 90% of patients. This involvement can extend from the mouth to the anus, with the oesophagus and anorectum most frequently affected. Gut complications result in a plethora of presentations that impair oral intake and faecal continence and, consequently, have an adverse effect on patient quality of life, resulting in referral to gastroenterologists. The cornerstones of gastrointestinal symptom management are to optimize symptom relief and monitor for complications, in particular anaemia and malabsorption. Early intervention in patients who develop these complications is critical to minimize disease progression and improve prognosis. In the future, enhanced therapeutic strategies should be developed, based on an ever-improving understanding of the intestinal pathophysiology of systemic sclerosis. This Review describes the most commonly occurring clinical scenarios of gastrointestinal involvement in patients with systemic sclerosis as they present to the gastroenterologist, with recommendations for the suggested assessment protocol and therapy in each situation.
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The author is supported by the National Institute of Health Research, University College London Hospitals Biomedical Research Centre.
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Emmanuel, A. Current management of the gastrointestinal complications of systemic sclerosis. Nat Rev Gastroenterol Hepatol 13, 461–472 (2016). https://doi.org/10.1038/nrgastro.2016.99
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DOI: https://doi.org/10.1038/nrgastro.2016.99
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