GI Endoscopy · 2 min read
Gastrointestinal Manifestations of Systemic Sclerosis
Experienced teaching points
Clinical Pearls
- Systemic sclerosis commonly affects the gastrointestinal tract through collagen deposition and muscular atrophy.
- Endoscopic evaluation may reveal esophageal dysmotility with dilation, megaduodenum, and mega ileum.
- Dilated bowel segments can delay transit and predispose to secondary bacterial overgrowth.
- Recognizing these patterns is essential for comprehensive management of scleroderma-related GI disease.
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CASE REPORT
Susan Feldman, MD and Klaus Mönkemüller, MD, PhD, FASGE, FESGE, FJGES, Department of Gastroenterology, Carilion Clinic / Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
Final Diagnosis
Esophageal motility disorder, mega duodenum, and mega ileum associated with systemic sclerosis.
Patient Demographics
A 48-year-old female with a known history of systemic sclerosis.
Clinical History
The patient was referred for malignancy screening. She reported dyspepsia and abdominal bloating. Her medications included mycophenolate mofetil. On clinical examination, her abdomen was slightly distended and tympanitic but non-tender. The indication for endoscopy was malignancy screening and evaluation of her gastrointestinal symptoms.
Endoscopic Findings
- Esophageal motility disorder and dilation with retained saliva.
- Markedly dilated duodenum with wide separation between Kerckring folds.
- Markedly dilated terminal ileum on colonoscopy.
Endoscopic Technique
Standard esophagogastroduodenoscopy and colonoscopy with terminal ileum intubation were performed for malignancy screening and symptom evaluation. No therapeutic intervention was required during this diagnostic examination.
Discussion
Systemic sclerosis, or scleroderma, is characterized by widespread collagen deposition, resulting in tissue and organ fibrosis. Most patients experience gastrointestinal manifestations, including esophageal dysmotility, gastroparesis, megaduodenum, small bowel diverticulosis, and chronic intestinal pseudo-obstruction. The gastrointestinal abnormalities are likely a consequence of muscular atrophy and collagen replacement of the outer longitudinal layer relative to the inner circular layer. Small intestinal involvement can lead to delayed transit, dilation of small bowel loops, and secondary bacterial overgrowth.
In this patient, the endoscopic triad of esophageal dilation with retained secretions, megaduodenum, and mega ileum illustrates how scleroderma can remodel multiple GI segments at once. Recognition matters because these findings explain common symptoms such as dyspepsia and bloating, and they raise the possibility of bacterial overgrowth when dilated loops impair clearance.
Key Learning Points
- Systemic sclerosis commonly affects the gastrointestinal tract due to collagen deposition and muscular atrophy.
- Endoscopic evaluation in patients with systemic sclerosis may reveal esophageal dysmotility, megaduodenum, and mega ileum.
- Gastrointestinal involvement can lead to dilated bowel segments and complications such as bacterial overgrowth.
- Recognition of these endoscopic findings is crucial for comprehensive management of systemic sclerosis.
References
- Prakash R, Saxena A. Gastrointestinal manifestations of systemic sclerosis. Gastroenterol Res Pract. 2017;2017:7102157.
- Runchey S, Sharma A. Esophageal dysmotility in systemic sclerosis: A review. J Clin Gastroenterol. 2021;55(8):666-673.
- Abu-Amara M, et al. Small bowel involvement in systemic sclerosis: Clinical and endoscopic features. World J Gastroenterol. 2011;17(30):3594-3599.
- Hokama A. Megaduodenum in systemic sclerosis. Rheumatology. 2022;61:e194.
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