#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Gastrointestinal involvement is systemic sclerosis – the consequences and treatment strategy


Authors: S. Oreská 1;  H. Štorkánová 1;  M. Špiritović 2;  B. Heřmánková 2;  M. Tomčík 1
Authors place of work: Revmatologický ústav a Revmatologická klinika 1. LF UK, Praha 1;  Katedra fyzioterapie, Fakulta tělesné výchovy a sportu UK, Praha 2
Published in the journal: Čes. Revmatol., 27, 2019, No. 1, p. 16-28.
Category: Review Article

Summary

Gastrointestinal tract (GIT) involvement is the most common internal organ manifestation in patients with systemic sclerosis (SSc). GIT involvement is present in up to 90% of SSc patients, with the clinical manifestations differing according to the disease course and the part of the GIT affected. The majority of the symptoms is caused by GIT dysmotility. Up to 8% of SSc patients develop severe GIT symptoms, which increase the mortality. Although GIT involvement is rarely the direct cause of death, it can lead to several comorbidities including malnutrition and negative alterations of body composition. These factors have a negative impact on quality of life and increase the mortality. To date, no specific treatment has been developed and the therapy is rather symptomatic. There is a need to clarify the pathogenesis of GIT involvement to improve the treatment approaches including e.g. intravenous immunoglobulins and miRNA interventions.

Keywords:

Gastrointestinal tract – systemic sclerosis – body composition – diagnosis management


Zdroje

1. Bharadwaj S, Tandon P, Gohel T, Corrigan ML, Coughlin KL, Shatnawei A, et al. Gastrointestinal Manifestations, Malnutrition, and Role of Enteral and Parenteral Nutrition in Patients With Scleroderma. J Clin Gastroenterol 2015; 49(7): 559–564.

2. Kumar S, Singh J, Rattan S, DiMarino AJ, Cohen S, Jimenez SA. Review article: pathogenesis and clinical manifestations of gastrointestinal involvement in systemic sclerosis. Aliment Pharmacol Ther 2017; 45(7): 883–898.

3. Gabrielli A, Avvedimento EV, Krieg T. Scleroderma. N Engl J Med 2009; 360(19): 1989–2003.

4. Piasecki C, Chin J, Greenslade L, McIntyre N, Burroughs AK, McCormick PA. Endoscopic detection of ischaemia with a new probe indicates low oxygenation of gastric epithelium in portal hypertensive gastropathy. Gut 1995; 36(5): 654–656.

5. Malandrini A, Selvi E, Villanova M, Berti G, Sabadini L, Salvadori C, et al. Autonomic nervous system and smooth muscle cell involvement in systemic sclerosis: ultrastructural study of 3 cases. J Rheumatol 2000; 27(5): 1203–1206.

6. Russell ML, Friesen D, Henderson RD, Hanna WM. Ultrastructure of the esophagus in scleroderma. Arthritis Rheum 1982; 25(9): 1117–1123.

7. Goldblatt F, Gordon TP, Waterman SA. Antibody-mediated gastrointestinal dysmotility in scleroderma. Gastroenterology 2002; 123(4): 1144–1150.

8. Kumar S, Singh J, Kedika R, Mendoza F, Jimenez SA, Blomain ES, et al. Role of muscarinic-3 receptor antibody in systemic sclerosis: correlation with disease duration and effects of IVIG. Am J Physiol Gastrointest Liver Physiol 2016; 310(11): G1052–1060.

9. Chizzolini C, Boin F. The role of the acquired immune response in systemic sclerosis. Semin Immunopathol 2015; 37(5): 519–528.

10. O’Reilly S, Hugle T, van Laar JM. T cells in systemic sclerosis: a reappraisal. Rheumatology (Oxford) 2012; 51(9): 1540–1549.

11. Raja J, Denton CP. Cytokines in the immunopathology of systemic sclerosis. Semin Immunopathol 2015; 37(5): 543–557.

12. Manetti M, Neumann E, Muller A, Schmeiser T, Saar P, Milia AF, et al. Endothelial/lymphocyte activation leads to prominent CD4+ T cell infiltration in the gastric mucosa of patients with systemic sclerosis. Arthritis Rheum 2008; 58(9): 2866–2873.

13. Manetti M, Neumann E, Milia AF, Tarner IH, Bechi P, Matucci-Cerinic M, et al. Severe fibrosis and increased expression of fibrogenic cytokines in the gastric wall of systemic sclerosis patients. Arthritis Rheum 2007; 56(10): 3442–3447.

14. Manetti M, Rosa I, Messerini L, Guiducci S, Matucci-Cerinic M, Ibba-Manneschi L. A loss of telocytes accompanies fibrosis of multiple organs in systemic sclerosis. J Cell Mol Med 2014; 18(2): 253–262.

15. Parker MW, Rossi D, Peterson M, Smith K, Sikstrom K, White ES, et al. Fibrotic extracellular matrix activates a profibrotic positive feedback loop. J Clin Invest 2014; 124(4): 1622–1635.

16. O’Reilly S. MicroRNAs in fibrosis: opportunities and challenges. Arthritis Res Ther 2016; 18: 11.

17. Jung S, Martin T, Schmittbuhl M, Huck O. The spectrum of orofacial manifestations in systemic sclerosis: a challenging management. Oral Dis 2017; 23(4): 424–439.

18. Avouac J, Sordet C, Depinay C, Ardizonne M, Vacher-Lavenu MC, Sibilia J, et al. Systemic sclerosis-associated Sjogren’s syndrome and relationship to the limited cutaneous subtype: results of a prospective study of sicca syndrome in 133 consecutive patients. Arthritis Rheum 2006; 54(7): 2243–2249.

19. Auluck A, Pai KM, Shetty C, Shenoi SD. Mandibular resorption in progressive systemic sclerosis: a report of three cases. Dentomaxillofac Radiol 2005; 34(6): 384–386.

20. Rajapakse CN, Bancewicz J, Jones CJ, Jayson MI. Pharyngo-oesophageal dysphagia in systemic sclerosis. Ann Rheum Dis 1981; 40(6): 612–614.

21. Derk CT, Rasheed M, Spiegel JR, Jimenez SA. Increased incidence of carcinoma of the tongue in patients with systemic sclerosis. J Rheumatol 2005; 32(4): 637–641.

22. Ntoumazios SK, Voulgari PV, Potsis K, Koutis E, Tsifetaki N, Assimakopoulos DA. Esophageal involvement in scleroderma: gastroesophageal reflux, the common problem. Semin Arthritis Rheum 2006; 36(3): 173–181.

23. Young MA, Rose S, Reynolds JC. Gastrointestinal manifestations of scleroderma. Rheum Dis Clin North Am 1996; 22(4): 797–823.

24. Shaheen N, Ransohoff DF. Gastroesophageal reflux, barrett esophagus, and esophageal cancer: scientific review. JAMA 2002; 287(15): 1972–1981.

25. Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 1991; 101(4 Pt 2 Suppl 53): 1–78.

26. Wipff J, Allanore Y, Soussi F, Terris B, Abitbol V, Raymond J, et al. Prevalence of Barrett’s esophagus in systemic sclerosis. Arthritis Rheum 2005; 52(9): 2882–2888.

27. Marie I, Dominique S, Levesque H, Ducrotte P, Denis P, Hellot MF, et al. Esophageal involvement and pulmonary manifestations in systemic sclerosis. Arthritis Rheum 2001; 45(4): 346–354.

28. Recht MP, Levine MS, Katzka DA, Reynolds JC, Saul SH. Barrett’s esophagus in scleroderma: increased prevalence and radiographic findings. Gastrointest Radiol 1988; 13(1): 1–5.

29. Weston S, Thumshirn M, Wiste J, Camilleri M. Clinical and upper gastrointestinal motility features in systemic sclerosis and related disorders. Am J Gastroenterol 1998; 93(7): 1085–1089.

30. Wipff J, Coriat R, Masciocchi M, Caramaschi P, Derk CT, Hachulla E, et al. Outcomes of Barrett’s oesophagus related to systemic sclerosis: a 3-year EULAR Scleroderma Trials and Research prospective follow-up study. Rheumatology (Oxford) 2011; 50(8): 1440–1444.

31. Richardson C, Agrawal R, Lee J, Almagor O, Nelson R, Varga J, et al. Esophageal dilatation and interstitial lung disease in systemic sclerosis: A cross-sectional study. Semin Arthritis Rheum 2016; 46(1): 109–114.

32. Marie I, Antonietti M, Houivet E, Hachulla E, Maunoury V, Bienvenu B, et al. Gastrointestinal mucosal abnormalities using videocapsule endoscopy in systemic sclerosis. Aliment Pharmacol Ther 2014; 40(2): 189–199.

33. Hung EW, Mayes MD, Sharif R, Assassi S, Machicao VI, Hosing C, et al. Gastric antral vascular ectasia and its clinical correlates in patients with early diffuse systemic sclerosis in the SCOT trial. J Rheumatol 2013; 40(4): 455–460.

34. Ingraham KM, O’Brien MS, Shenin M, Derk CT, Steen VD. Gastric antral vascular ectasia in systemic sclerosis: demographics and disease predictors. J Rheumatol 2010; 37(3): 603–607.

35. Lazzaroni MG, Cavazzana I, Colombo E, Dobrota R, Hernandez J, Hesselstrand R, et al. Malignancies in patients with anti-RNA polymerase III antibodies and systemic sclerosis: analysis of the EULAR scleroderma trials and research cohort and possible recommendations for screening. J Rheumatol 2017; 44(5): 639–647.

36. Polkowska-Pruszynska B, Gerkowicz A, Szczepanik-Kulak P, Krasowska D. Small intestinal bacterial overgrowth in systemic sclerosis: a review of the literature. Arch Dermatol Res 2019; 311(1): 1–8.

37. Bures J, Cyrany J, Kohoutova D, Forstl M, Rejchrt S, Kvetina J, et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol 2010; 16(24): 2978–2990.

38. Grace E, Shaw C, Whelan K, Andreyev HJ. Review article: small intestinal bacterial overgrowth – prevalence, clinical features, current and developing diagnostic tests, and treatment. Aliment Pharmacol Ther 2013; 38(7): 674–688.

39. Valenzuela A, Li S, Becker L, Fernandez-Becker N, Khanna D, Nguyen L, et al. Intestinal pseudo-obstruction in patients with systemic sclerosis: an analysis of the Nationwide Inpatient Sample. Rheumatology (Oxford) 2016; 55(4): 654–658.

40. Marie I, Ducrotte P, Denis P, Menard JF, Levesque H. Small intestinal bacterial overgrowth in systemic sclerosis. Rheumatology (Oxford) 2009; 48(10): 1314–1319.

41. Balbir-Gurman A, Brook OR, Chermesh I, Braun-Moscovici Y. Pneumatosis cystoides intestinalis in scleroderma-related conditions. Intern Med J 2012; 42(3): 323–329.

42. Assassi S, Fritzler MJ, Arnett FC, Norman GL, Shah KR, Gourh P, et al. Primary biliary cirrhosis (PBC), PBC autoantibodies, and hepatic parameter abnormalities in a large population of systemic sclerosis patients. J Rheumatol 2009; 36(10): 2250–2256.

43. Reynolds TB, Denison EK, Frankl HD, Lieberman FL, Peters RL. Primary biliary cirrhosis with scleroderma, Raynaud’s phenomenon and telangiectasia. New syndrome. Am J Med 1971; 50(3): 302–312.

44. Cavazzana I, Ceribelli A, Taraborelli M, Fredi M, Norman G, Tincani A, et al. Primary biliary cirrhosis-related autoantibodies in a large cohort of italian patients with systemic sclerosis. J Rheumatol 2011; 38(10): 2180–2185.

45. Rigamonti C, Shand LM, Feudjo M, Bunn CC, Black CM, Denton CP, et al. Clinical features and prognosis of primary biliary cirrhosis associated with systemic sclerosis. Gut 2006; 55(3): 388–394.

46. Caporali R, Caccialanza R, Bonino C, Klersy C, Cereda E, Xoxi B, et al. Disease-related malnutrition in outpatients with systemic sclerosis. Clin Nutr 2012; 31(5): 666–671.

47. Krause L, Becker MO, Brueckner CS, Bellinghausen CJ, Becker C, Schneider U, et al. Nutritional status as marker for disease activity and severity predicting mortality in patients with systemic sclerosis. Ann Rheum Dis 2010; 69(11): 1951–1957.

48. Baron M, Hudson M, Steele R, Canadian Scleroderma Research G. Malnutrition is common in systemic sclerosis: results from the Canadian scleroderma research group database. J Rheumatol 2009; 36(12): 2737–2743.

49. Baron M, Bernier P, Cote LF, Delegge MH, Falovitch G, Friedman G, et al. Screening and therapy for malnutrition and related gastro-intestinal disorders in systemic sclerosis: recommendations of a North American expert panel. Clin Exp Rheumatol 2010; 28(2 Suppl 58): S42–46.

50. Tanner SB, Moore CF, Jr. A review of the use of dual-energy X-ray absorptiometry (DXA) in rheumatology. Open Access Rheumatol 2012; 4: 99–107.

51. Frediani B, Baldi F, Falsetti P, Acciai C, Filippou G, Spreafico A, et al. Bone mineral density in patients with systemic sclerosis. Ann Rheum Dis 2004; 63(3): 326–327.

52. Carbone L, Tylavsky F, Wan J, McKown K, Cheng S. Bone mineral density in scleroderma. Rheumatology (Oxford) 1999; 38(4): 371–372.

53. Corrado A, Colia R, Mele A, Di Bello V, Trotta A, Neve A, et al. Relationship between body mass composition, bone mineral density, skin fibrosis and 25(OH) vitamin D serum levels in systemic sclerosis. PLoS One 2015; 10(9): e0137912.

54. Marighela TF, Genaro Pde S, Pinheiro MM, Szejnfeld VL, Kayser C. Risk factors for body composition abnormalities in systemic sclerosis. Clin Rheumatol 2013; 32(7): 1037–1044.

55. Rosato E, Gigante A, Gasperini ML, Molinaro I, Di Lazzaro Giraldi G, Afeltra A, et al. Nutritional status measured by BMI is impaired and correlates with left ventricular mass in patients with systemic sclerosis. Nutrition 2014; 30(2): 204–209.

56. Caramaschi P, Biasi D, Caimmi C, Barausse G, Gatti D, Ferrari M, et al. Relationship between body composition and both cardiovascular risk factors and lung function in systemic sclerosis. Clin Rheumatol 2014; 33(1): 77–82.

57. Vardar R, Keskin M. Indications of 24-h esophageal pH monitoring, capsule pH monitoring, combined pH monitoring with multichannel impedance, esophageal manometry, radiology and scintigraphy in gastroesophageal reflux disease? Turk J Gastroenterol 2017; 28(Suppl 1): S16–S21.

58. Nagaraja V, McMahan ZH, Getzug T, Khanna D. Management of gastrointestinal involvement in scleroderma. Curr Treatm Opt Rheumatol 2015; 1(1): 82–105.

59. Braun-Moscovici Y, Brun R, Braun M. Systemic sclerosis and the gastrointestinal tract-clinical approach. Rambam Maimonides Med J 2016; 7(4).

60. Rezaie A, Pimentel M, Rao SS. How to test and treat small intestinal bacterial overgrowth: an evidence-based approach. Curr Gastroenterol Rep 2016; 18(2): 8.

61. Khanna D, Hays RD, Park GS, Braun-Moscovici Y, Mayes MD, McNearney TA, et al. Development of a preliminary scleroderma gastrointestinal tract 1.0 quality of life instrument. Arthritis Rheum 2007; 57(7): 1280–1286.

62. Khanna D, Hays RD, Maranian P, Seibold JR, Impens A, Mayes MD, et al. Reliability and validity of the University of California, Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract Instrument. Arthritis Rheum 2009; 61(9): 1257–1263.

63. Spiegel BM, Hays RD, Bolus R, Melmed GY, Chang L, Whitman C, et al. Development of the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) gastrointestinal symptom scales. Am J Gastroenterol 2014; 109(11): 1804–1814.

64. Nagaraja V, Hays RD, Khanna PP, Spiegel BM, Chang L, Melmed GY, et al. Construct validity of the Patient-Reported Outcomes Measurement Information System gastrointestinal symptom scales in systemic sclerosis. Arthritis Care Res (Hoboken) 2014; 66(11): 1725–1730.

65. McMahan ZH, Frech T, Berrocal V, Lim D, Bruni C, Matucci-Cerinic M, et al. Longitudinal assessment of Patient-reported Outcome Measures in systemic sclerosis patients with gastroesophageal reflux disease – scleroderma clinical trials consortium. J Rheumatol 2019; 46(1): 78–84.

66. Stratton RJ, Hackston A, Longmore D, Dixon R, Price S, Stroud M, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‚malnutrition universal screening tool‘ (‚MUST‘) for adults. Br J Nutr 2004; 92(5): 799–808.

67. Kowal-Bielecka O, Fransen J, Avouac J, Becker M, Kulak A, Allanore Y, et al. Update of EULAR recommendations for the treatment of systemic sclerosis. Ann Rheum Dis 2017; 76(8): 1327–1339.

68. Raja J, Nihtyanova SI, Murray CD, Denton CP, Ong VH. Sustained benefit from intravenous immunoglobulin therapy for gastrointestinal involvement in systemic sclerosis. Rheumatology (Oxford) 2016; 55(1): 115–119.

69. Clark KE, Etomi O, Denton CP, Ong VH, Murray CD. Intravenous immunogobulin therapy for severe gastrointestinal involvement in systemic sclerosis. Clin Exp Rheumatol 2015; 33(4 Suppl 91): S168–170.

70. Ciechomska M, van Laar J, O’Reilly S. Current frontiers in systemic sclerosis pathogenesis. Exp Dermatol 2015; 24(6): 401–406.

Štítky
Dermatology & STDs Paediatric rheumatology Rheumatology
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#