Summary
In 24 patients with progressive systemic sclerosis (PSS) the pentagastrin-stimulated gastric acid secretion was determined to investigate if acid hypersecretion is associated with reflux-oesophagitis — the most common complication to oesophageal involvement in PSS. Gastro-oesophageal reflux was observed in 12, reflux-oesophagitis in 9 and oesophageal mycosis in 8 patients. Gastric acid secretion was increased in 13 (54%) patients and tended to be higher in patients with oesophagitis. Patients with reflux and increased acid secretion seemed to be free from oesophageal mycosis. Bacterial overgrowth and malabsorption are known complications to intestinal scleroderma and these items were investigated using non-invasive methods. Four patients had increased bile acid deconjugation, 3 had increased (14C)xylose degradation indicating bacterial overgrowth and 7 patients had decreased fat absorption in the triolein breath test. Nutritional status with respect to selenium, folate, cobalamine and fat-soluble vitamins was essentially normal.
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Myers, A.R. Progressive systemic sclerosis. Gastrointestinal involvement. Clin Rheum Dis, 1979, 5, 115–129.
Cohen, S., Laufer, I., Snape, W.J., Shiau, Y-F., Levine, G.M., Jimenez, S. The gastrointestinal manifestations of scleroderma: Pathogenesis and management. Gastroenterology, 1980, 79, 155–166.
King, C.E., Toskes, P.P. Small intestine bacterial overgrowth. Gastroenterology, 1979, 76, 1035–1055.
Fromm, H., Hofmann, A.F. Breath test for altered bile-acid metabolism. Lancet, 1971, II, 621–625.
Lauterburg, B.H., Newcomer, A.D., Hofmann, A.F. Clinical value of the bile acid breath test. Mayo Clin Proc, 1978, 53, 227–233.
King, C.E., Toskes, P.P., Spivey, J.C., Spivey, E.L., Welkos, S. Detection of small intestine bacterial overgrowth by means of al4C-D-xylose breath test. Gastroenterology, 1979, 77, 75–82.
Masi, A.T., Rodnan, G.P., Medsger, T.A., Altman, R.D., D'Angelo, W.A., Fries, J.F., LeRoy, E.C., Kirsner, A.B., MacKenzie, A.H., McShane, D.J., Myers, A.R., Sharp, G.C. Preliminary criteria for the classification of systemic sclerosis (scleroderma). Arthritis Rheum, 1980, 23, 581–590.
King, C.E., Toskes, P.P., Guilarte, T.R., Lorenz, E., Welkos, S.L. Comparison of the one-gram d-(14C)xylose breath test to the (14C)bile acid breath test in patients with small-intestine bacterial overgrowth. Dig Dis Sci, 1980, 25, 53–58.
Åkesson, B., Florén, C.H. Use of the triolein breath test for demonstration of fat malabsorption in coeliac disease. Scand J Gastroenterol, 1984, 19, 307–314.
Åkesson, B., Öckerman, P.A. Selenium status in vegans and lactovegetarians. Br J Nutr, 1985, 53, 199–205.
Günzler, W.A., Kremers, H., Flohé, L. An improved coupled test procedure for glutathione peroxidase in blood. Z Klin Chem Klin Biochem, 1974, 12, 444–448.
De Leenheer, A.P., De Bevere, V.O.R.C., De Ruyter, M.G.M., Claeys, A.E. Simultaneous determination of retinol and -αtocopherol in human serum by high-performance liquid chromatography. J. Chromatogr, 1979, 162, 408–413.
Skinner, R.K., Wills, M.R. Serum 25-hydroxyvitamin D assay. Evaluation of Chromatographic and non-chromatographic procedures. Clin Chim Acta, 1977, 80, 543–554.
Bendixen, G., Jarnum, S., Ottesen, O., Schmidt, H., Thomsen, K. Gastrointestinal involvement in systemic scleroderma. Dermatologica, 1968, 137, 26–35.
Helm, J.F., Dodds, W.J., Pelc, L.R., Palmer, D.W., Hogan, W.J., Teeter, B.C. Effect of esophageal emptying and saliva on clearance of acid from the esophagus. N. Engl J Med, 1984, 310, 284–288.
Rees, W.D., Leigh, R.J. Christofides, N.D., Bloom, S.R., Turnberg, L.A. Interdigestive motor activity in patients with systemic sclerosis. Gastroenterology, 1982, 83, 575–580.
Taylor, I.L. Gastrointestinal hormones in the pathogenesis of peptic ulcer disease. Clin Gastroenterol, 1984, 13, 355–382.
Kochina, E.N., Grebenav, A.L., Napalkova, N.N., Tsvetkova, L.I., Joffe, V.S. Gastrin content in blood serum of patients with systemic scleroderma. Ter Arkh, 1981, 53, 47–49.
Kahn, I.J., Jeffries, G.H., Sleisenger, M.H. Malabsorption in intestinal scleroderma. N Engl J Med, 1966, 274, 1339–1344.
Salen, G., Goldstein, F., Wirts, C.W. Malabsorption in intestinal scleroderma. Ann Intern Med, 1966, 64, 834–841.
Meihoff, W.E., Hirschfield, J.S., Kern, F. Jr. Small intestinal scleroderma with malabsorption and pneumatosis cystoides intestinalis. JAMA, 1968, 204, 102–106.
Scudamore, H.H., Green, P.A., Hofmann, H.N., Roseear, J.W. Scleroderma of the small intestine with malabsorption. Am J Gastroent, 1968, 49, 193–208.
Cobden, I., Axon, A.T., Rowell, N.R. Pancreatic exocrine function in systemic sclerosis. Br J Dermatol, 1981, 105, 189–193.
Newcomer, A.D., Hofman, A.F., DiMagno, E.P., Thomas, P.J. Triolein breath test. A sensitive and specific test for fat malabsorption. Gastroenterology, 1979, 76, 6–13.
Blom-Bülow, B., Öberg, K., Wollheim, F., Persson, B., Jonson, B., Malmberg, P., Boström, H., Herbai, G. Cyclofenil versus placebo in progressive systemic sclerosis. Acta Med Scand, 1981, 210, 419–428.
Aaseth, J., Munthe, E., Førre, Ø., Skinnes, E. Trace elements in serum and urine of patients with rheumatoid arthritis. Scand J Rheumatol, 1978, 7, 237–240.
Åkesson, B., Johansson, U., Öckerman, P.A., Portinsson, S., Åkesson, A., Svantesson, H. Selenium status in patients with juvenile chronic arthritis. Trace Element Analytical Chemistry in Medicine and Biology, Eds: Brättner, P., Schramel, P. de Gruyter & Co, Berlin, 1984, 3, 167–174.
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Åkesson, A., Åkesson, B., Gustafson, T. et al. Gastrointestinal function in patients with progressive systemic sclerosis. Clin Rheumatol 4, 441–448 (1985). https://doi.org/10.1007/BF02031897
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DOI: https://doi.org/10.1007/BF02031897