Severe GI tract involvement in early systemic sclerosis

Severe GI tract involvement is a principal symptom in the early disease stage in a subset of patients with systemic sclerosis (SSc). However, their disease is scarcely associated with interstitial lung disease (ILD), even in those patients who have diffuse cutaneous SSc.

Nishimagi and associates compared the clinical features of Japanese patients who had SSc and severe GI tract involvement (eg, malabsorption syndrome and pseudo-obstruction) within 2 years of the first symptom (group 1) with 2 control groups-all patients without severe GI tract involvement and patients without severe GI tract involvement within 2 years of the onset of SSc. All patients were assessed by echocardiography and tested for antinuclear antibodies (ANAs).

The frequencies of esophagitis and myositis were significantly higher in group 1 than in the control groups, but ILD was significantly more frequent in the control groups. There was no difference in the frequency of ANAs among the groups, but ANAs with nucleolar staining by indirect immunofluorescence were significantly more frequent in group 1.

The authors noted that smooth muscle injury in the GI tract may play a crucial role in the development of severe GI tract involvement in SSc.