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Early endoscopy in systemic sclerosis without gastrointestinal symptoms

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Abstract

Investigation into the upper GI-tract of patients suffering from systemic sclerosis [SSc] and mixed connective tissue disease [MCTD] without symptoms of GI-tract involvement early in the course of the disease to diagnose inflammatory and motility disorders. We retrospectively analysed patients with SSc and MCTD who underwent oesophago-gastro-duodenoscopy [OGD] within a year of the first diagnosis. Patients with a Rodnan skin score above 5, proton pump inhibitors and treatment regimes potentially harmful to the mucosa of the upper GI-tract were excluded. Mucosal damage of the oesophagus was classified according to the Los Angeles Classification. Oesophageal dysmotility was assessed during OGD and confirmed by video cineradiography. A total of thirteen patients with SSc and six with MCTD fulfilled the inclusion criteria. OGD revealed reflux-oesophagitis in 77%, dysmotility of the distal oesophagus in 85%, gastritis in 92% [31% erosive gastritis] and Helicobacter pylori positivity in 38% of our patients suffering from SSc. Patients with MCTD showed features of reflux-oesophagitis, dysmotility of the distal oesophagus, gastritis and dysmotility of the stomach in 0.6%. In all thirteen patients with SSc, significant pathology of the upper GI-tract was found. The results of this study might indicate that OGD should be performed early in patients diagnosed with SSc, even if they do not report typical symptoms. An early diagnose of GI involvement might be followed by an effective therapy and therefore subsequently may improve the prognosis.

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References

  1. Marie I, Ducrotte P, Denis P, Hellot MF, Levesque H (2006) Oesophageal mucosal involvement in patients with systemic sclerosis receiving proton pump inhibitor therapy. Aliment Pharmacol Ther 24:1593–1601

    Article  PubMed  CAS  Google Scholar 

  2. Weihrauch TR, Korting GW, Ewe K, Vogt G (1978) Esophageal dysfunction and its pathogenesis in progressive systemic sclerosis. Klin Wochenschr 56:963–968

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  5. Yarze JC, Varga J, Stampfl D, Castell DO, Jimenez SA (1993) Esophageal function in systemic sclerosis: a prospective evaluation of motility and acid reflux in 36 patients. Am J Gastroenterol 88:870–876

    PubMed  CAS  Google Scholar 

  6. Yamamoto M, Takahashi H, Akaike J, Suzuki C, Naishiro Y, Yamamoto H et al (2008) Gastric antral vascular ectasia (GAVE) associated with systemic sclerosis. Scand J Rheumatol 37:315–316

    Article  PubMed  CAS  Google Scholar 

  7. Marie I, Levesque H, Ducrotté P, Denis P, Hellot MF, Benichou J et al (2001) Gastric involvement in systemic sclerosis: a prospective study. Am J Gastroenterol 96:77–83

    Article  PubMed  CAS  Google Scholar 

  8. Nishimagi E, Tochimoto A, Kawaguchi Y, Satoh T, Kuwana M, Takagi K et al (2007) Characteristics of patients with early systemic sclerosis and severe gastrointestinal tract involvement. J Rheumatol 34:2050–2055

    PubMed  Google Scholar 

  9. Szamosi S, Szekanecz Z, Szucs G (2006) Gastrointestinal manifestations in Hungarian scleroderma patients. Rheumatol Int 26:1120–1124

    Article  PubMed  Google Scholar 

  10. Tsianos EB, Drosos AA, Chiras CD, Moutsopoulos HM, Kitridou RC (1987) Esophageal manometric findings in autoimmune rheumatic diseases: is scleroderma esophagus a specific entity? Rheumatol Int 7:23–27

    Article  PubMed  CAS  Google Scholar 

  11. Sandqvist G, Eklund M, Akesson A, Nordenskiöld U (2004) Daily activities and hand function in women with scleroderma. Scand J Rheumatol 33:102–107

    Article  PubMed  CAS  Google Scholar 

  12. Steen VD, Medsger TA Jr (2000) Severe organ involvement in systemic sclerosis with diffuse scleroderma. Arthritis Rheum 43:2437–2444

    Article  PubMed  CAS  Google Scholar 

  13. Wegener M, Adamek RJ, Wedmann B, Jergas M, Altmeyer P (1994) Gastrointestinal transit through esophagus, stomach, small and large intestine in patients with progressive systemic sclerosis. Dig Dis Sci 39:2209–2215

    Article  PubMed  CAS  Google Scholar 

  14. Treacy WL, Baggenstoss AH, Slocumb CH, Code CF (1963) Scleroderma of the esophagus. A correlation of histologic and physiologic findings. Ann Intern Med 59:351–356

    PubMed  CAS  Google Scholar 

  15. LeRoy EC, Black C, Fleischmajer R, Jablonska S, Krieg T, Medsger TA Jr, Rowell N, Wollheim F (1988) Scleroderma (systemic sclerosis): classification, subsets and pathogenesis. J Rheumatol 15:202–205

    PubMed  CAS  Google Scholar 

  16. LeRoy EC, Medsger TA Jr (2001) Criteria fort he Classification of early systemic sclerosis. J Rheumatol 28:1573–1576

    PubMed  CAS  Google Scholar 

  17. von Mühlen CA, Tan EM (1995) Autoantibodies in the diagnosis of systemic rheumatic diseases. Semin Arthritis Rheum 24:323–358

    Article  Google Scholar 

  18. Alarcón-Segovia D, Cardiel MH (1989) Comparison between 3 diagnostic criteria for mixed connective tissue disease. Study of 593 patients. J Rheumatol 16:328–334

    PubMed  Google Scholar 

  19. Sharp GC, Irvin WS, Tan EM, Gould RG, Holman HR (1972) Mixed connective tissue disease–an apparently distinct rheumatic disease syndrome associated with a specific antibody to an extractable nuclear antigen (ENA). Am J Med 52:148–159

    Article  PubMed  CAS  Google Scholar 

  20. Lambova SN, Müller-Ladner U (2009) The role of capillaroscopy in differentiation of primary and secondary Raynaud’s phenomenon in rheumatic diseases: a review of the literature and two case reports. Rheumatol Int 29:1263–1271

    Article  PubMed  Google Scholar 

  21. Furst DE, Clements PJ, Steen VD, Medsger TA Jr, Masi AT, D’Angelo WA et al (1998) The modified Rodnan skin score is an accurate reflection of skin biopsy thickness in systemic sclerosis. J Rheumatol 25:84–88

    PubMed  CAS  Google Scholar 

  22. Clements P, Lachenbruch P, Siebold J, White B, Weiner S, Martin R et al (1995) Inter and intraobserver variability of total skin thickness score (modified Rodnan TSS) in systemic sclerosis. J Rheumatol 22:1281–1285

    PubMed  CAS  Google Scholar 

  23. Armstrong D, Bennett JR, Blum AL, Dent J, De Dombal FT, Galmiche JP et al (1996) The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology 111:85–92

    Article  PubMed  CAS  Google Scholar 

  24. Mantzaris GJ, Petraki K, Archavlis E, Amberiadis P, Christoforidis P, Kourtessas D et al (2002) Omeprazole triple therapy versus omeprazole quadruple therapy for healing duodenal ulcer and eradication of Helicobacter pylori infection: a 24-month follow-up study. Eur J Gastroenterol Hepatol 14:1237–1243

    Article  PubMed  CAS  Google Scholar 

  25. Doria A, Bonavina L, Anselmino M, Ruffatti A, Favaretto M, Gambari P et al (1991) Esophageal involvement in mixed connective tissue disease. J Rheumatol 18:685–690

    PubMed  CAS  Google Scholar 

  26. Franck-Larsson K, Hedenström H, Dahl R, Rönnblom A (2003) Delayed gastric emptying in patients with diffuse versus limited systemic sclerosis, unrelated to gastrointestinal symptoms and myoelectric gastric activity. Scand J Rheumatol 32:348–355

    Article  PubMed  CAS  Google Scholar 

  27. Hendel L, Hage E, Hendel J, Stentoft P (1992) Omeprazole in the long-term treatment of severe gastro-oesophageal reflux disease in patients with systemic sclerosis. Aliment Pharmacol Ther 6:565–577

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Deptartment of Internal Medicine, State Hospital Muerzzuschlag, Landeskrankenhaus Mürzzuschlag, Grazer Strasse 63-65, 8680, Mürzzuschlag, Austria

    Rene Thonhofer, Cornelia Siegel & Markus Trummer

  2. Division of Rheumatology, Deptartment of Internal Medicine, Medical University Graz, Graz, Austria

    Rene Thonhofer & Winfried Graninger

Authors
  1. Rene Thonhofer
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  2. Cornelia Siegel
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  3. Markus Trummer
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  4. Winfried Graninger
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Correspondence to Rene Thonhofer.

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Thonhofer, R., Siegel, C., Trummer, M. et al. Early endoscopy in systemic sclerosis without gastrointestinal symptoms. Rheumatol Int 32, 165–168 (2012). https://doi.org/10.1007/s00296-010-1595-y

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  • DOI: https://doi.org/10.1007/s00296-010-1595-y

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