Small intestinal involvement in systemic sclerosis

Introduction. - Though impairment of the gastrointestinal tract is commonly encountered in patients with systemic sclerosis, the most frequent abnorma lities are esophageal and anorectal disorders. Involvement of the small int estine is also common, reaching a 40-80% prevalence. It often leads to life -threatening complications. Current knowledge and key points. - The occurrence of small intestine impai rment and its potential relationships with other organ impairment is still unknown. However, it rarely indicates the existence of rite disease (10%) w hich remains asymptomatic for a long period As clinical symptoms are non-sp ecific and radiological tests (upper intestinal tract barium meal, gastroin testinal transit times of radiolabeled meal, computerized tomography scan) not sensitive enough to detect the symptoms, diagnosis of small intestine i mpairment is delayed i.e., when severe complications such as malabsorption or pseudo-obstruction are present. The physiopathology of small intestine d isorders is still unclear, leading to both collagenous fibrosis and atrophy of muscle fibers. As well, its treatment is difficult. Future prospects and projects. - Knowledge of the mechanisms at the origin of small intestine impairment in the course of systemic sclerosis is import ant for the development of efficacious therapies. Manometry of the small in testine would be a useful tool to assess the various motor abnormalities th at may occur in patients presenting with systemic sclerosis associated with either malabsorption or pseudo-obstruction. It would also provide a useful lest in selecting patients whose treatment require somatostatin analogs. ( C) 1999 Elsevier, Paris.