Clinical Assessment of Gastrointestinal Involvement in Patients with Systemic Sclerosis

Abstract

Systemic sclerosis (SSc) is an autoimmune connective tissue disease that negatively impacts the function of the skin and internal organs. The gastrointestinal (GI) tract is the most commonly affected internal organ in SSc, though GI complications may also arise indirectly when infections occur in the setting of immunosuppression or concurrent disease processes arise for which patients with SSc are found to be at higher risk. In this review, we provide a systematic approach for the clinical assessment of GI complications in SSc from the oropharynx to the anorectum to guide both general internists and rheumatologists caring for this complex patient population. It is organized so that each component of the luminal GI tract has its own specified section, beginning with a review of a clinical approach to diagnosis, followed by a more detailed discussion of the literature surrounding approaches for an objective GI evaluation. A focused discussion early in the manuscript addressing what is known about pathogenesis, and later about in the manuscript about the assessment for GI bleeding are also included.