Organs involvement in SSc

Q: Which of the following organs is relatively more involved in systemic sclerosis (scleroderma / SSc)? (select one)

A) Gastrointestinal  

B) Pulmonary 

Answer: A

Almost 90 percent of patients with SSc have some level of gastrointestinal (GI) involvement, in contrast to pulmonary involvement, which is at about 80 percent. As pulmonary hypertension is one of the dreaded complications of SSc, GI symptoms are usually not as commonly highlighted. Patients with SSc may frequently have dysphagia, choking sensation, heartburn, hoarseness, cough after swallowing, early satiety, bloating, alternating constipation and diarrhea, episodic pseudo-obstruction and bacterial small bowel overgrowth with malabsorption, and fecal incontinence. Other manifestations are vascular ectasia (angiodysplasia) in the antrum of the stomach ("watermelon stomach"), causing unexplained gastrointestinal bleeding and anemia. 

It should be noted that GI symptoms may be contributing to pulmonary symptoms due to long-term microaspiration and the development of Interstitial Lung Disease (ILD).

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References:

1. Nassar M, Ghernautan V, Nso N, Nyabera A, Castillo FC, Tu W, Medina L, Ciobanu C, Alfishawy M, Rizzo V, Eskaros S, Mahdi M, Khalifa M, El-Kassas M. Gastrointestinal involvement in systemic sclerosis: An updated review. Medicine (Baltimore). 2022 Nov 11;101(45):e31780. doi: 10.1097/MD.0000000000031780. PMID: 36397401; PMCID: PMC9666124.

2. Skare T, Culpi M, Yokoo P, Dias M. Gastrointestinal symptoms in scleroderma patients and its influence in body mass index and quality of life. Acta Reumatol Port. 2014 Jul-Sep;39(3):242-7. PMID: 25326404.

3. Marie I, Dominique S, Levesque H, et al. Esophageal involvement and pulmonary manifestations in systemic sclerosis. Arthritis Rheum 2001; 45:346.