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Upper Gastrointestinal Tract

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Scleroderma

Abstract

Systemic sclerosis (SSc) is a chronic connective tissue disorder with multisystem involvement. The gastrointestinal (GI) tract is affected in up to 90% of patients (LeRoy EC, Black C, Fleischmajer R, et al. Scleroderma (systemic sclerosis): classification, subsets and pathogenesis. J Rheumatol. 1988;15:202–5.; Clements PJ, Becvar R, Drosos AA, Ghattas L, Gabrielli A. Assessment of gastrointestinal involvement. Clin Exp Rheumatol. 2003;21:S15–8; Forbes A, Marie I. Gastrointestinal complications: the most frequent internal complications of systemic sclerosis. Rheumatology (Oxford). 2009;48(Suppl 3):iii36–9.) and gut involvement is a leading cause of morbidity. Symptoms vary based on location of involvement and degree of impairment; however, dysphagia, reflux, nausea, vomiting, pain, diarrhea, constipation, fecal incontinence, and weight loss are commonly reported. GI involvement severely impacts quality of life and is a major cause of morbidity and mortality associated with SSc (Steen VD, Medsger TA. Changes in causes of death in systemic sclerosis, 1972–2002. Ann Rheum Dis. 2007;66:940–4).

While the esophagus is the most widely described site of GI involvement, SSc can affect any site within the GI tract from the mouth to the anus. This chapter will focus on foregut manifestations of SSc, ranging from the mouth to stomach with an emphasis on both motility and bleeding. Involvement of other regions of the GI tract will be detailed in other chapters.

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References

  1. LeRoy EC, Black C, Fleischmajer R, et al. Scleroderma (systemic sclerosis): classification, subsets and pathogenesis. J Rheumatol. 1988;15:202–5.

    PubMed  CAS  Google Scholar 

  2. Clements PJ, Becvar R, Drosos AA, Ghattas L, Gabrielli A. Assessment of gastrointestinal involvement. Clin Exp Rheumatol. 2003;21:S15–8.

    PubMed  CAS  Google Scholar 

  3. Forbes A, Marie I. Gastrointestinal complications: the most frequent internal complications of systemic sclerosis. Rheumatology (Oxford). 2009;48(Suppl 3):iii36–9.

    Google Scholar 

  4. Steen VD, Medsger TA. Changes in causes of death in systemic sclerosis, 1972–2002. Ann Rheum Dis. 2007;66:940–4.

    PubMed  Google Scholar 

  5. Vitali C, Borghi E, Napoletano A, et al. Oropharyngolaryngeal disorders in scleroderma: development and validation of the SLS scale. Dysphagia. 2010;25:127–38.

    PubMed  Google Scholar 

  6. Scardina GA, Mazzullo M, Messina P. Early diagnosis of progressive systemic sclerosis: the role of oro-facial phenomena. Minerva Stomatol. 2002;51:311–7.

    PubMed  CAS  Google Scholar 

  7. Domsic R, Fasanella K, Bielefeldt K. Gastrointestinal manifestations of systemic sclerosis. Dig Dis Sci. 2008;53:1163–74.

    PubMed  Google Scholar 

  8. Roberts CG, Hummers LK, Ravich WJ, Wigley FM, Hutchins GM. A case-control study of the pathology of oesophageal disease in systemic sclerosis (scleroderma). Gut. 2006;55:1697–703.

    PubMed  CAS  Google Scholar 

  9. Thoua NM, Bunce C, Brough G, Forbes A, Emmanuel AV, Denton CP. Assessment of gastrointestinal symptoms in patients with systemic sclerosis in a UK tertiary referral centre. Rheumatology (Oxford). 2010;49:1770–5.

    Google Scholar 

  10. Sjogren RW. Gastrointestinal motility disorders in scleroderma. Arthritis Rheum. 1994;37:1265–82.

    PubMed  CAS  Google Scholar 

  11. Howe S, Eaker EY, Sallustio JE, Peebles C, Tan EM, Williams Jr RC. Antimyenteric neuronal antibodies in scleroderma. J Clin Invest. 1994;94:761–70.

    PubMed  CAS  Google Scholar 

  12. Goldblatt F, Gordon TP, Waterman SA. Antibody-mediated gastrointestinal dysmotility in scleroderma. Gastroenterology. 2002;123:1144–50.

    PubMed  CAS  Google Scholar 

  13. Cohen S, Fisher R, Lipshutz W, Turner R, Myers A, Schumacher R. The pathogenesis of esophageal dysfunction in scleroderma and Raynaud’s disease. J Clin Invest. 1972;51:2663–8.

    PubMed  CAS  Google Scholar 

  14. Dessein PH, Joffe BI, Metz RM, Millar DL, Lawson M, Stanwix AE. Autonomic dysfunction in systemic sclerosis: sympathetic overactivity and instability. Am J Med. 1992;93:143–50.

    PubMed  CAS  Google Scholar 

  15. Zuber-Jerger I, Muller A, Kullmann F, et al. Gastrointestinal manifestation of systemic sclerosis–thickening of the upper gastrointestinal wall detected by endoscopic ultrasound is a valid sign. Rheumatology (Oxford). 2010;49:368–72.

    Google Scholar 

  16. Ostojic P, Damjanov N. Different clinical features in patients with limited and diffuse cutaneous systemic sclerosis. Clin Rheumatol. 2006;25:453–7.

    PubMed  Google Scholar 

  17. Ebert EC. Esophageal disease in scleroderma. J Clin Gastroenterol. 2006;40:769–75.

    PubMed  Google Scholar 

  18. Ebert EC. Esophageal disease in progressive systemic sclerosis. Curr Treat Options Gastroenterol. 2008;11:64–9.

    PubMed  Google Scholar 

  19. Abu-Shakra M, Guillemin F, Lee P. Gastrointestinal manifestations of systemic sclerosis. Semin Arthritis Rheum. 1994;24:29–39.

    PubMed  CAS  Google Scholar 

  20. Ling TC, Johnston BT. Esophageal investigations in connective tissue disease: which tests are most appropriate? J Clin Gastroenterol. 2001;32:33–6.

    PubMed  CAS  Google Scholar 

  21. Kaye SA, Siraj QH, Agnew J, Hilson A, Black CM. Detection of early asymptomatic esophageal dysfunction in systemic sclerosis using a new scintigraphic grading method. J Rheumatol. 1996;23:297–301.

    PubMed  CAS  Google Scholar 

  22. Harper RA, Jackson DC. Progressive systemic sclerosis. Br J Radiol. 1965;38:825–34.

    PubMed  CAS  Google Scholar 

  23. Weston S, Thumshirn M, Wiste J, Camilleri M. Clinical and upper gastrointestinal motility features in systemic sclerosis and related disorders. Am J Gastroenterol. 1998;93:1085–9.

    PubMed  CAS  Google Scholar 

  24. El-Serag HB, Sonnenberg A. Association of esophagitis and esophageal strictures with diseases treated with nonsteroidal anti-inflammatory drugs. Am J Gastroenterol. 1997;92:52–6.

    PubMed  CAS  Google Scholar 

  25. Zamost BJ, Hirschberg J, Ippoliti AF, Furst DE, Clements PJ, Weinstein WM. Esophagitis in scleroderma. Prevalence and risk factors. Gastroenterology. 1987;92:421–8.

    PubMed  CAS  Google Scholar 

  26. Katzka DA, Reynolds JC, Saul SH, et al. Barrett’s metaplasia and adenocarcinoma of the esophagus in scleroderma. Am J Med. 1987;82:46–52.

    PubMed  CAS  Google Scholar 

  27. Segel MC, Campbell WL, Medsger Jr TA, Roumm AD. Systemic sclerosis (scleroderma) and esophageal adenocarcinoma: is increased patient screening necessary? Gastroenterology. 1985;89:485–8.

    PubMed  CAS  Google Scholar 

  28. Denis P, Ducrotte P, Pasquis P, Lefrancois R. Esophageal motility and pulmonary function in progressive systemic sclerosis. Respiration. 1981;42:21–4.

    PubMed  CAS  Google Scholar 

  29. Johnson DA, Drane WE, Curran J, et al. Pulmonary disease in progressive systemic sclerosis. A complication of gastroesophageal reflux and occult aspiration? Arch Intern Med. 1989;149:589–93.

    PubMed  CAS  Google Scholar 

  30. Lock G, Pfeifer M, Straub RH, et al. Association of esophageal dysfunction and pulmonary function impairment in systemic sclerosis. Am J Gastroenterol. 1998;93:341–5.

    PubMed  CAS  Google Scholar 

  31. Marie I, Dominique S, Levesque H, et al. Esophageal involvement and pulmonary manifestations in systemic sclerosis. Arthritis Rheum. 2001;45:346–54.

    PubMed  CAS  Google Scholar 

  32. Kinuya K, Nakajima K, Kinuya S, Michigishi T, Tonami N, Takehara K. Esophageal hypomotility in systemic sclerosis: close relationship with pulmonary involvement. Ann Nucl Med. 2001;15:97–101.

    PubMed  CAS  Google Scholar 

  33. Troshinsky MB, Kane GC, Varga J, et al. Pulmonary function and gastroesophageal reflux in systemic sclerosis. Ann Intern Med. 1994;121:6–10.

    PubMed  CAS  Google Scholar 

  34. Savarino E, Bazzica M, Zentilin P, et al. Gastroesophageal reflux and pulmonary fibrosis in scleroderma: a study using pH-impedance monitoring. Am J Respir Crit Care Med. 2009;179:408–13.

    PubMed  Google Scholar 

  35. Christmann RB, Wells AU, Capelozzi VL, Silver RM. Gastroesophageal reflux incites interstitial lung disease in systemic sclerosis: clinical, radiologic, histopathologic, and treatment evidence. Semin Arthritis Rheum. 2010;40:241–9.

    PubMed  Google Scholar 

  36. Olive A, Juncosa S, Evison G, Maddison PJ. Air in the oesophagus: a sign of oesophageal involvement in systemic sclerosis. Clin Rheumatol. 1995;14:319–21.

    PubMed  CAS  Google Scholar 

  37. Madani G, Katz RD, Haddock JA, Denton CP, Bell JR. The role of radiology in the management of systemic sclerosis. Clin Radiol. 2008;63:959–67.

    PubMed  CAS  Google Scholar 

  38. Clements PJ, Kadell B, Ippoliti A, Ross M. Esophageal motility in progressive systemic sclerosis (PSS). Comparison of cine-radiographic and manometric evaluation. Dig Dis Sci. 1979;24:639–44.

    PubMed  CAS  Google Scholar 

  39. Weihrauch TR, Korting GW. Manometric assessment of oesophageal involvement in progressive systemic sclerosis, morphoea and Raynaud’s disease. Br J Dermatol. 1982;107:325–32.

    PubMed  CAS  Google Scholar 

  40. Jayanthi V, Srinivasan V, Nayak VM, Krishnamurthi V, Victor S. Comparative evaluation of cine-esophagogram with esophageal manometry in assessing esophageal motility in progressive systemic sclerosis. Indian J Gastroenterol. 1996;15:129–31.

    PubMed  CAS  Google Scholar 

  41. Klein HA, Wald A, Graham TO, Campbell WL, Steen VD. Comparative studies of esophageal function in systemic sclerosis. Gastroenterology. 1992;102:1551–6.

    PubMed  CAS  Google Scholar 

  42. Lock G, Zeuner M, Straub RH, et al. Esophageal manometry in systemic sclerosis: screening procedure or confined to symptomatic patients? Rheumatol Int. 1997;17:61–6.

    PubMed  Google Scholar 

  43. Bassotti G, Battaglia E, Debernardi V, et al. Esophageal dysfunction in scleroderma: relationship with disease subsets. Arthritis Rheum. 1997;40:2252–9.

    PubMed  CAS  Google Scholar 

  44. Thonhofer R, Siegel C, Trummer M, Graninger W. Early endoscopy in systemic sclerosis without gastrointestinal symptoms. Rheumatol Int. 2010. [epub ahead of print].

    Google Scholar 

  45. Marie I, Ducrotte P, Denis P, Hellot MF, Levesque H. Oesophageal mucosal involvement in patients with systemic sclerosis receiving proton pump inhibitor therapy. Aliment Pharmacol Ther. 2006;24:1593–601.

    PubMed  CAS  Google Scholar 

  46. Wegener M, Adamek RJ, Wedmann B, Jergas M, Altmeyer P. Gastrointestinal transit through esophagus, stomach, small and large intestine in patients with progressive systemic sclerosis. Dig Dis Sci. 1994;39:2209–15.

    PubMed  CAS  Google Scholar 

  47. Rajapakse CN, Bancewicz J, Jones CJ, Jayson MI. Pharyngo-oesophageal dysphagia in systemic sclerosis. Ann Rheum Dis. 1981;40:612–4.

    PubMed  CAS  Google Scholar 

  48. Mainie I, Tutuian R, Patel A, Castell DO. Regional esophageal dysfunction in scleroderma and achalasia using multichannel intraluminal impedance and manometry. Dig Dis Sci. 2008;53:210–6.

    PubMed  Google Scholar 

  49. Hirano I, Richter JE. ACG practice guidelines: esophageal reflux testing. Am J Gastroenterol. 2007;102:668–85.

    PubMed  Google Scholar 

  50. Carlo-Stella N, Belloli L, Barbera R, et al. Gastroesophageal reflux and lung disease in systemic sclerosis. Am J Respir Crit Care Med. 2009;179:1167. author reply −8.

    PubMed  Google Scholar 

  51. Kahan A, Bour B, Couturier D, Amor B, Menkes CJ. Nifedipine and esophageal dysfunction in progressive systemic sclerosis. A controlled manometric study. Arthritis Rheum. 1985;28:490–5.

    PubMed  CAS  Google Scholar 

  52. Jean F, Aubert A, Bloch F, et al. Effects of diltiazem versus nifedipine on lower esophageal sphincter pressure in patients with progressive systemic sclerosis. Arthritis Rheum. 1986;29:1054–5.

    PubMed  CAS  Google Scholar 

  53. Kowal-Bielecka O, Landewe R, Avouac J, et al. EULAR recommendations for the treatment of systemic sclerosis: a report from the EULAR Scleroderma Trials and Research group (EUSTAR). Ann Rheum Dis. 2009;68:620–8.

    PubMed  CAS  Google Scholar 

  54. Olive A, Maddison PJ, Davis M. Treatment of oesophagitis in scleroderma with omeprazole. Br J Rheumatol. 1989;28:553.

    PubMed  CAS  Google Scholar 

  55. Hendel L. Hydroxyproline in the oesophageal mucosa of patients with progressive systemic sclerosis during omeprazole-induced healing of reflux oesophagitis. Aliment Pharmacol Ther. 1991;5:471–80.

    PubMed  CAS  Google Scholar 

  56. Shoenut JP, Wieler JA, Micflikier AB. The extent and pattern of gastro-oesophageal reflux in patients with scleroderma oesophagus: the effect of low-dose omeprazole. Aliment Pharmacol Ther. 1993;7:509–13.

    PubMed  CAS  Google Scholar 

  57. Gough A, Andrews D, Bacon PA, Emery P. Evidence of omeprazole-induced small bowel bacterial overgrowth in patients with scleroderma. Br J Rheumatol. 1995;34:976–7.

    PubMed  CAS  Google Scholar 

  58. Hendel L, Aggestrup S, Stentoft P. Long-term ranitidine in progressive systemic sclerosis (scleroderma) with gastroesophageal reflux. Scand J Gastroenterol. 1986;21:799–805.

    PubMed  CAS  Google Scholar 

  59. Petrokubi RJ, Jeffries GH. Cimetidine versus antacid in scleroderma with reflux esophagitis. A randomized double-blind controlled study. Gastroenterology. 1979;77:691–5.

    PubMed  CAS  Google Scholar 

  60. Janiak P, Thumshirn M, Menne D, et al. Clinical trial: the effects of adding ranitidine at night to twice daily omeprazole therapy on nocturnal acid breakthrough and acid reflux in patients with systemic sclerosis–a randomized controlled, cross-over trial. Aliment Pharmacol Ther. 2007;26:1259–65.

    PubMed  CAS  Google Scholar 

  61. Horowitz M, Maddern GJ, Maddox A, Wishart J, Chatterton BE, Shearman DJ. Effects of cisapride on gastric and esophageal emptying in progressive systemic sclerosis. Gastroenterology. 1987;93:311–5.

    PubMed  CAS  Google Scholar 

  62. Wehrmann T, Caspary WF. Effect of cisapride on esophageal motility in healthy probands and patients with progressive systemic scleroderma. Klin Wochenschr. 1990;68:602–7.

    PubMed  CAS  Google Scholar 

  63. Kahan A, Chaussade S, Gaudric M, et al. The effect of cisapride on gastro-oesophageal dysfunction in systemic sclerosis: a controlled manometric study. Br J Clin Pharmacol. 1991;31:683–7.

    PubMed  CAS  Google Scholar 

  64. Limburg AJ, Smit AJ, Kleibeuker JH. Effects of cisapride on the esophageal motor function of patients with progressive systemic sclerosis or mixed connective tissue disease. Digestion. 1991;49:156–60.

    PubMed  CAS  Google Scholar 

  65. Wang SJ, La JL, Chen DY, Chen YH, Hsieh TY, Lin WY. Effects of cisapride on oesophageal transit of solids in patients with progressive systemic sclerosis. Clin Rheumatol. 2002;21:43–5.

    PubMed  CAS  Google Scholar 

  66. Ramirez-Mata M, Ibanez G, Alarcon-Segovia D. Stimulatory effect of metoclopramide on the esophagus and lower esophageal sphincter of patients of patients with PSS. Arthritis Rheum. 1977;20:30–4.

    PubMed  CAS  Google Scholar 

  67. Johnson DA, Drane WE, Curran J, et al. Metoclopramide response in patients with progressive systemic sclerosis. Effect on esophageal and gastric motility abnormalities. Arch Intern Med. 1987;147:1597–601.

    PubMed  CAS  Google Scholar 

  68. Drane WE, Karvelis K, Johnson DA, Curran JJ, Silverman ED. Scintigraphic detection of metoclopramide esophageal stimulation in ­progressive systemic sclerosis. J Nucl Med. 1987;28:810–5.

    PubMed  CAS  Google Scholar 

  69. Sridhar KR, Lange RC, Magyar L, Soykan I, McCallum RW. Prevalence of impaired gastric emptying of solids in systemic sclerosis: diagnostic and therapeutic implications. J Lab Clin Med. 1998;132:541–6.

    PubMed  CAS  Google Scholar 

  70. Mercado U, Arroyo de Anda R, Avendano L, Araiza-Casillas R, Avendano-Reyes M. Metoclopramide response in patients with early diffuse systemic sclerosis. Effects on esophageal motility abnormalities. Clin Exp Rheumatol. 2005;23:685–8.

    PubMed  CAS  Google Scholar 

  71. Fiorucci S, Distrutti E, Bassotti G, et al. Effect of erythromycin administration on upper gastrointestinal motility in scleroderma patients. Scand J Gastroenterol. 1994;29:807–13.

    PubMed  CAS  Google Scholar 

  72. Folwaczny C, Laritz M, Meurer M, Endres SP, Konig A, Schindlbeck N. Effects of various prokinetic drugs on gastrointestinal transit times in patients with progressive systemic scleroderma. Z Gastroenterol. 1997;35:905–12.

    PubMed  CAS  Google Scholar 

  73. Sjogren RW. Gastrointestinal features of scleroderma. Curr Opin Rheumatol. 1996;8:569–75.

    PubMed  CAS  Google Scholar 

  74. Henderson RD, Pearson FG. Surgical management of esophageal scleroderma. J Thorac Cardiovasc Surg. 1973;66:686–92.

    PubMed  CAS  Google Scholar 

  75. Orringer MB, Orringer JS, Dabich L, Zarafonetis CJ. Combined Collis gastroplasty–fundoplication operations for scleroderma reflux esophagitis. Surgery. 1981;90:624–30.

    PubMed  CAS  Google Scholar 

  76. Mansour KA. Surgery for scleroderma of the esophagus: a 12-year experience. Updated in 1995. Ann Thorac Surg. 1988;60:227.

    Google Scholar 

  77. Poirier NC, Taillefer R, Topart P, Duranceau A. Antireflux operations in patients with scleroderma. Ann Thorac Surg. 1994;58:66–72. ­discussion −3.

    PubMed  CAS  Google Scholar 

  78. Kent MS, Luketich JD, Irshad K, et al. Comparison of surgical approaches to recalcitrant gastroesophageal reflux disease in the patient with scleroderma. Ann Thorac Surg. 2007;84:1710–5. discussion 5–6.

    PubMed  Google Scholar 

  79. Szamosi S, Szekanecz Z, Szucs G. Gastrointestinal manifestations in Hungarian scleroderma patients. Rheumatol Int. 2006;26:1120–4.

    PubMed  Google Scholar 

  80. Sallam H, McNearney TA, Chen JD. Systematic review: pathophysiology and management of gastrointestinal dysmotility in systemic sclerosis (scleroderma). Aliment Pharmacol Ther. 2006;23:691–712.

    PubMed  CAS  Google Scholar 

  81. Marie I, Ducrotte P, Antonietti M, Herve S, Levesque H. Watermelon stomach in systemic sclerosis: its incidence and management. Aliment Pharmacol Ther. 2008;28:412–21.

    PubMed  CAS  Google Scholar 

  82. Ingraham KM, O’Brien MS, Shenin M, Derk CT, Steen VD. Gastric antral vascular ectasia in systemic sclerosis: demographics and disease predictors. J Rheumatol. 2010;37:603–7.

    PubMed  Google Scholar 

  83. Maddern GJ, Horowitz M, Jamieson GG, Chatterton BE, Collins PJ, Roberts-Thomson P. Abnormalities of esophageal and gastric emptying in progressive systemic sclerosis. Gastroenterology. 1984;87:922–6.

    PubMed  CAS  Google Scholar 

  84. Marie I, Levesque H, Ducrotte P, et al. Gastric involvement in systemic sclerosis: a prospective study. Am J Gastroenterol. 2001;96:77–83.

    PubMed  CAS  Google Scholar 

  85. Fiorucci S, Distrutti E, Gerli R, Morelli A. Effect of erythromycin on gastric and gallbladder emptying and gastrointestinal symptoms in scleroderma patients is maintained medium term. Am J Gastroenterol. 1994;89:550–5.

    PubMed  CAS  Google Scholar 

  86. Pfaffenbach B, Adamek RJ, Hagemann D, et al. Effect of progressive systemic sclerosis on antral myoelectrical activity and gastric emptying. Z Gastroenterol. 1996;34:517–21.

    PubMed  CAS  Google Scholar 

  87. Franck-Larsson K, Hedenstrom H, Dahl R, Ronnblom A. Delayed gastric emptying in patients with diffuse versus limited systemic sclerosis, unrelated to gastrointestinal symptoms and myoelectric gastric activity. Scand J Rheumatol. 2003;32:348–55.

    PubMed  CAS  Google Scholar 

  88. Marycz T, Muehldorfer SM, Gruschwitz MS, et al. Gastric involvement in progressive systemic sclerosis: electrogastrographic and sonographic findings. Eur J Gastroenterol Hepatol. 1999;11:1151–6.

    PubMed  CAS  Google Scholar 

  89. Mittal BR, Wanchu A, Das BK, Ghosh PP, Sewatkar AB, Misra RN. Pattern of gastric emptying in patients with systemic sclerosis. Clin Nucl Med. 1996;21:379–82.

    PubMed  CAS  Google Scholar 

  90. Wedmann B, Wegener M, Adamek RJ, el Gammal S. Gastrobiliary motility after liquid fatty meal in progressive systemic sclerosis. A sonographic study. Dig Dis Sci. 1994;39:565–70.

    PubMed  CAS  Google Scholar 

  91. Abell TL, Camilleri M, Donohoe K, et al. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. Am J Gastroenterol. 2008;103:753–63.

    PubMed  Google Scholar 

  92. Talley NJ. Diabetic gastropathy and prokinetics. Am J Gastroenterol. 2003;98:264–71.

    PubMed  Google Scholar 

  93. Bortolotti M, Bolondi L, Santi V, Sarti P, Brunelli F, Barbara L. Patterns of gastric emptying in dysmotility-like dyspepsia. Scand J Gastroenterol. 1995;30:408–10.

    PubMed  CAS  Google Scholar 

  94. Tang DM, Friedenberg FK. Gastroparesis: approach, diagnostic evaluation, and management. Dis Mon. 2011;57:74–101.

    PubMed  Google Scholar 

  95. Cassilly D, Kantor S, Knight LC, et al. Gastric emptying of a non-digestible solid: assessment with simultaneous SmartPill pH and pressure capsule, antroduodenal manometry, gastric emptying scintigraphy. Neurogastroenterol Motil. 2008;20:311–9.

    PubMed  CAS  Google Scholar 

  96. Kuo B, McCallum RW, Koch KL, et al. Comparison of gastric emptying of a nondigestible capsule to a radio-labelled meal in healthy and gastroparetic subjects. Aliment Pharmacol Ther. 2008;27:186–96.

    PubMed  CAS  Google Scholar 

  97. Parkman HP. Assessment of gastric emptying and small-bowel motility: scintigraphy, breath tests, manometry, and smartpill. Gastrointest Endosc Clin N Am. 2009;19:49–55. vi.

    PubMed  Google Scholar 

  98. Rees WD, Leigh RJ, Christofides ND, Bloom SR, Turnberg LA. Interdigestive motor activity in patients with systemic sclerosis. Gastroenterology. 1982;83:575–80.

    PubMed  CAS  Google Scholar 

  99. Marie I, Levesque H, Ducrotte P, et al. Manometry of the upper intestinal tract in patients with systemic sclerosis: a prospective study. Arthritis Rheum. 1998;41:1874–83.

    PubMed  CAS  Google Scholar 

  100. McNearney TA, Sallam HS, Hunnicutt SE, et al. Gastric slow waves, gastrointestinal symptoms and peptides in systemic sclerosis patients. Neurogastroenterol Motil. 2009;21:1269–e120.

    PubMed  Google Scholar 

  101. Tung A, Sweitzer B, Cutter T. Cardiac arrest after labetalol and metoclopramide administration in a patient with scleroderma. Anesth Analg. 2002;95:1667–8. table of contents.

    PubMed  Google Scholar 

  102. Patterson D, Abell T, Rothstein R, Koch K, Barnett J. A double-blind multicenter comparison of domperidone and metoclopramide in the treatment of diabetic patients with symptoms of gastroparesis. Am J Gastroenterol. 1999;94:1230–4.

    PubMed  CAS  Google Scholar 

  103. Parkman HP, Jacobs MR, Mishra A, et al. Domperidone treatment for gastroparesis: demographic and pharmacogenetic characterization of clinical efficacy and side-effects. Dig Dis Sci. 2011;56:115–24.

    PubMed  CAS  Google Scholar 

  104. Verne GN, Eaker EY, Hardy E, Sninsky CA. Effect of octreotide and erythromycin on idiopathic and scleroderma-associated intestinal pseudoobstruction. Dig Dis Sci. 1995;40:1892–901.

    PubMed  CAS  Google Scholar 

  105. Masaoka T, Tack J. Gastroparesis: current concepts and management. Gut Liver. 2009;3:166–73.

    PubMed  Google Scholar 

  106. Maganti K, Onyemere K, Jones MP. Oral erythromycin and symptomatic relief of gastroparesis: a systematic review. Am J Gastroenterol. 2003;98:259–63.

    PubMed  CAS  Google Scholar 

  107. Linke R, Meier M, Muenzing W, Folwaczny C, Schnell O, Tatsch K. Prokinetic therapy: what can be measured by gastric scintigraphy? Nucl Med Commun. 2005;26:527–33.

    PubMed  Google Scholar 

  108. Wu KL, Rayner CK, Chuah SK, et al. Effects of ginger on gastric emptying and motility in healthy humans. Eur J Gastroenterol Hepatol. 2008;20:436–40.

    PubMed  Google Scholar 

  109. Chaiyakunapruk N, Kitikannakorn N, Nathisuwan S, Leeprakobboon K, Leelasettagool C. The efficacy of ginger for the prevention of postoperative nausea and vomiting: a meta-analysis. Am J Obstet Gynecol. 2006;194:95–9.

    PubMed  Google Scholar 

  110. Wollaston DE, Xu X, Tokumaru O, Chen JD, McNearney TA. Patients with systemic sclerosis have unique and persistent alterations in gastric myoelectrical activity with acupressure to Neiguan point PC6. J Rheumatol. 2005;32:494–501.

    PubMed  Google Scholar 

  111. Sallam H, McNearney TA, Doshi D, Chen JD. Transcutaneous electrical nerve stimulation (TENS) improves upper GI symptoms and balances the sympathovagal activity in scleroderma patients. Dig Dis Sci. 2007;52:1329–37.

    PubMed  Google Scholar 

  112. Friedenberg FK, Palit A, Parkman HP, Hanlon A, Nelson DB. Botulinum toxin A for the treatment of delayed gastric emptying. Am J Gastroenterol. 2008;103:416–23.

    PubMed  CAS  Google Scholar 

  113. Duchini A, Sessoms SL. Gastrointestinal hemorrhage in patients with systemic sclerosis and CREST syndrome. Am J Gastroenterol. 1998;93:1453–6.

    PubMed  CAS  Google Scholar 

  114. Jabbari M, Cherry R, Lough JO, Daly DS, Kinnear DG, Goresky CA. Gastric antral vascular ectasia: the watermelon stomach. Gastroenterology. 1984;87:1165–70.

    PubMed  CAS  Google Scholar 

  115. Gostout CJ, Viggiano TR, Ahlquist DA, Wang KK, Larson MV, Balm R. The clinical and endoscopic spectrum of the watermelon stomach. J Clin Gastroenterol. 1992;15:256–63.

    PubMed  CAS  Google Scholar 

  116. Suit PF, Petras RE, Bauer TW, Petrini Jr JL. Gastric antral vascular ectasia. A histologic and morphometric study of “the watermelon stomach”. Am J Surg Pathol. 1987;11:750–7.

    PubMed  CAS  Google Scholar 

  117. Chawla SK, Ramani K, Lo Presti P. The honeycomb stomach: coalesced gastric angiodysplasia. Gastrointest Endosc. 1990;36:516–8.

    PubMed  CAS  Google Scholar 

  118. Sebastian S, O’Morain CA, Buckley MJ. Review article: current therapeutic options for gastric antral vascular ectasia. Aliment Pharmacol Ther. 2003;18:157–65.

    PubMed  CAS  Google Scholar 

  119. Dulai GS, Jensen DM. Treatment of watermelon stomach. Curr Treat Options Gastroenterol. 2006;9:175–80.

    PubMed  Google Scholar 

  120. Lorenzi AR, Johnson AH, Davies G, Gough A. Gastric antral vascular ectasia in systemic sclerosis: complete resolution with methylprednisolone and cyclophosphamide. Ann Rheum Dis. 2001;60:796–8.

    PubMed  CAS  Google Scholar 

  121. Schulz SW, O’Brien M, Maqsood M, Sandorfi N, Del Galdo F, Jimenez SA. Improvement of severe systemic sclerosis-associated gastric antral vascular ectasia following immunosuppressive treatment with intravenous cyclophosphamide. J Rheumatol. 2009;36:1653–6.

    PubMed  CAS  Google Scholar 

  122. Tran A, Villeneuve JP, Bilodeau M, et al. Treatment of chronic bleeding from gastric antral vascular ectasia (GAVE) with estrogen-­progesterone in cirrhotic patients: an open pilot study. Am J Gastroenterol. 1999;94:2909–11.

    PubMed  CAS  Google Scholar 

  123. Kantsevoy SV, Cruz-Correa MR, Vaughn CA, Jagannath SB, Pasricha PJ, Kalloo AN. Endoscopic cryotherapy for the treatment of bleeding mucosal vascular lesions of the GI tract: a pilot study. Gastrointest Endosc. 2003;57:403–6.

    PubMed  Google Scholar 

  124. Cho S, Zanati S, Yong E, et al. Endoscopic cryotherapy for the management of gastric antral vascular ectasia. Gastrointest Endosc. 2008;68:895–902.

    PubMed  Google Scholar 

  125. Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med. 2009;360:2277–88.

    PubMed  CAS  Google Scholar 

  126. Gross SA, Al-Haddad M, Gill KR, Schore AN, Wallace MB. Endoscopic mucosal ablation for the treatment of gastric antral vascular ectasia with the HALO90 system: a pilot study. Gastrointest Endosc. 2008;67:324–7.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Johns Hopkins University, Baltimore, MD, USA

    John O. Clarke MD

  2. Gastroenterology Division, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Ikuo Hirano MD

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  1. John O. Clarke MD
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  2. Ikuo Hirano MD
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Correspondence to John O. Clarke MD .

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  1. Feinberg School of Medicine, Northwestern University, E. Huron Street 240, Chicago, 60611-2909, Illinois, USA

    John Varga

  2. Royal Free and University College, Medical School, University College London, Rowland Street, London, NW3 2PF, United Kingdom

    Christopher P. Denton

  3. School of Medicine, Div. Rheumatology, Johns Hopkins University, Eastern Avenue 5200, Baltimore, 21224, Maryland, USA

    Fredrick M. Wigley

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Clarke, J.O., Hirano, I. (2012). Upper Gastrointestinal Tract. In: Varga, J., Denton, C., Wigley, F. (eds) Scleroderma. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-5774-0_40

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