Systemic sclerosis gastrointestinal dysmotility: risk factors, pathophysiology, diagnosis and management

Nearly all patients with systemic sclerosis (SSc) are negatively affected by dysfunction in the gastrointestinal tract, and the severity of gastrointestinal disease in SSc correlates with high mortality. The clinical complications of this dysfunction are heterogeneous and include gastro-oesophageal reflux disease, gastroparesis, small intestinal bacterial overgrowth, intestinal pseudo-obstruction, malabsorption and the requirement for total parenteral nutrition. The abnormal gastrointestinal physiology that promotes the clinical manifestations of SSc gastrointestinal disease throughout the gastrointestinal tract are diverse and present a range of therapeutic targets. Furthermore, the armamentarium of medications and non-pharmacological interventions that can benefit affected patients has substantially expanded in the past 10 years, and research is increasingly focused in this area. Here, we review the details of the gastrointestinal complications in SSc, tie physiological abnormalities to clinical manifestations, detail the roles of standard and novel therapies and lay a foundation for future investigative work. Gastrointestinal dysmotility is a major complication of systemic sclerosis but remains poorly understood. In this Review, the authors discuss the current understanding of systemic sclerosis gastrointestinal disease, existing and emerging therapies, and promising directions for future research

Automated summary

The dysfunction of the gastrointestinal tract in patients with systemic sclerosis (SSc) has a negative impact on their health, and the severity of gastrointestinal disease in SSc is associated with high mortality. The clinical complications of this dysfunction are diverse and include various digestive disorders. There are multiple therapeutic targets throughout the gastrointestinal tract and a wide range of medications and interventions available for affected patients. This review discusses the details of gastrointestinal complications in SSc, links physiological abnormalities to clinical manifestations, and explores both standard and novel therapies, thus providing a foundation for future research.