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Gastrointestinal involvement in systemic sclerosis: diagnosis and management

McMahan, Zsuzsanna H.; Hummers, Laura K.

Current Opinion in Rheumatology: November 2018 - Volume 30 - Issue 6 - p 533–540
doi: 10.1097/BOR.0000000000000545
RAYNAUD PHENOMENON, SCLERODERMA, OVERLAP SYNDROMES AND OTHER FIBROSING SYNDROMES: Edited by John Varga

Purpose of review This review provides important updates in systemic sclerosis (SSc)-related gastrointestinal disease, with a particular focus on the diagnosis and management of dysmotility.

Recent findings In the past 2 years, several studies were published that present interesting diagnostic insights into SSc and gastrointestinal dysmotility. Studies focusing on new therapies and the novel application of existing therapies, both in SSc and non-SSc-associated gastrointestinal dysmotility syndromes, demonstrate progress in the management of these challenging complications.

Summary SSc gastrointestinal disease is heterogeneous in its clinical presentation, which presents a challenge in diagnosis and management. Objective studies may help to identify patterns of gastrointestinal dysmotility and more specifically target therapy. A variety of drugs are now available or are under study in the management of gastrointestinal dysmotility, such as prucalopride, intravenous immunoglobulin, pyridostigmine, linaclotide, relamorelin, and others. These drugs may improve symptoms and quality of life in SSc gastrointestinal patients. Combination therapies are also under study. Electroacupuncture, dietary intervention (e.g. medical nutrition therapy, low FODmap diet), and medical cannibus may also play a role in alleviating patient symptoms; however, more data are needed to define the role of these interventions in SSc.

Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Correspondence to Zsuzsanna H. McMahan, MD, MHS, 5200 Eastern Ave, Suite 4100, Mason F Lord building Center Tower, Baltimore, MD 21224, USA. Tel: +1 410 550 2003; fax: +1 410 550 2072; e-mail: zmcmaha1@jhmi.edu

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