Gastrointestinal Involvement in Systemic Sclerosis

Diagnosis and Management

Zsuzsanna H. McMahan; Laura K. Hummers

Disclosures

Curr Opin Rheumatol. 2018;30(6):533-540. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: This review provides important updates in systemic sclerosis (SSc)-related gastrointestinal disease, with a particular focus on the diagnosis and management of dysmotility.

Recent findings: In the past 2 years, several studies were published that present interesting diagnostic insights into SSc and gastrointestinal dysmotility. Studies focusing on new therapies and the novel application of existing therapies, both in SSc and non-SSc-associated gastrointestinal dysmotility syndromes, demonstrate progress in the management of these challenging complications.

Summary: SSc gastrointestinal disease is heterogeneous in its clinical presentation, which presents a challenge in diagnosis and management. Objective studies may help to identify patterns of gastrointestinal dysmotility and more specifically target therapy. A variety of drugs are now available or are under study in the management of gastrointestinal dysmotility, such as prucalopride, intravenous immunoglobulin, pyridostigmine, linaclotide, relamorelin, and others. These drugs may improve symptoms and quality of life in SSc gastrointestinal patients. Combination therapies are also under study. Electroacupuncture, dietary intervention (e.g. medical nutrition therapy, low FODmap diet), and medical cannibus may also play a role in alleviating patient symptoms; however, more data are needed to define the role of these interventions in SSc.

Introduction

The gastrointestinal tract is the most commonly affected internal organ in systemic sclerosis (SSc).[1,2] Up to 90% of patients experience symptoms of upper and/or lower gastrointestinal dysmotility, which may be associated with significant morbidity and mortality.[3] Heterogeneity in the clinical presentation of SSc patients complicates risk stratification and diagnosis, and limited effective therapeutic options complicate treatment strategies.[4]

In the past year, exciting updates in the field of gastrointestinal disease related to the diagnosis and management of patients with or without SSc were published. In addition, expert driven recommendations for the treatment of gastrointestinal complications relevant to SSc were updated, providing useful information for practicing rheumatologists, gastroenterologists, and general practitioners.[5–7] This review will focus on gastrointestinal dysmotility, highlighting new diagnostic and therapeutic data with relevance to this important complication in SSc.

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