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Upper Gastrointestinal Tract: Manifestations of Systemic Sclerosis

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Scleroderma

Abstract

The gastrointestinal tract is the most common organ system affected by systemic sclerosis (SSc) other than the skin. Greater than 90 % of SSc patients have esophageal involvement, and this primarily manifests as reflux and dysphagia. In addition to symptoms, complications include stricture, candidal esophagitis, and Barrett’s esophagus. There is an association between esophageal dysmotility and pulmonary disease, although causality has not been established. Gastric involvement is less common and can manifest as dysmotility or bleeding. Dysmotility often presents with impaired gastric emptying and associated symptoms, including nausea, postprandial fullness, bloating, and weight loss. Bleeding is often due to gastric antral vascular ectasia. While this affects a minority of SSc patients, consequences can be significant. This chapter will review the data regarding foregut manifestations and specifically will focus on diagnostic modalities and treatment options – including lifestyle modification, medical therapy, alternative therapy, endoscopic options, and surgical approaches where appropriate. Unfortunately, treatment remains supportive at present, and there is a lack of disease-modifying therapeutic options.

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Authors and Affiliations

  1. Division of Gastroenterology & Hepatology, Johns Hopkins University, Baltimore, MD, USA

    John O. Clarke MD

  2. Division of Gastroenterology & Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    John E. Pandolfino MD, MS

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  1. John O. Clarke MD
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  2. John E. Pandolfino MD, MS
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Correspondence to John O. Clarke MD .

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Editors and Affiliations

  1. Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

    John Varga

  2. Division of Medicine, Department of Inflammation, Centre for Rheumatology and Connective Tissue Diseases, UCL Division of Medicine, Royal Free Hospital, London, United Kingdom

    Christopher P. Denton

  3. Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA

    Fredrick M. Wigley

  4. Service de Rhumatologie A, INSERMU1016, Universit. Paris Descartes, Hôpital Cochin, Paris, France

    Yannick Allanore

  5. Department of Allergy and Rheumatology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan

    Masataka Kuwana

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Clarke, J.O., Pandolfino, J.E. (2017). Upper Gastrointestinal Tract: Manifestations of Systemic Sclerosis. In: Varga, J., Denton, C., Wigley, F., Allanore, Y., Kuwana, M. (eds) Scleroderma. Springer, Cham. https://doi.org/10.1007/978-3-319-31407-5_30

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