ISCHEMIA OF THE SMALL-INTESTINE IN PATIENTS WITH SYSTEMIC-SCLEROSIS -RAYNAUDS-PHENOMENON OR CHRONIC VASCULOPATHY

We investigated duodenal and gastric mucosal blood flow by endoscopic laser Doppler flowmetery (LDF) in ten patients with systemic sclerosis (SSc) and in ten healthy volunteers. In addition, we tested for the p resence of small bowel bacterial overgrowth by jejunal aspiration. jej unal aspiration and LDF were done consecutively, via a gastroscope, us ing a flexible catheter and laser Doppler probe. Following these proce dures, two duodenal biopsies were obtained for light and electron micr oscopy. Mean duodenal and gastric blood flow were significantly lower in patients with SSc than in normal subjects (516 flux units vs. 240, 521 vs. 202, both p < 0.001). There was no correlation between age and blood flow in patients or volunteers. Four of the ten patients had ev idence of significant bacterial overgrowth on jejunal aspiration (> 10 (5) colony-forming units/ml). These findings support the hypothesis th at within the small intestine of patients with SSc, factors independen t of bacterial overgrowth may be responsible for malabsorption. The ob served reduction in small-intestine mucosal blood flow may play an imp ortant contributary role. Further studies are required to determine wh ether this represents reversible or chronic progressive ischaemia, and its effect on nutrient absorption.