Upper Gastrointestinal Tract: Manifestations of Systemic Sclerosis

The gastrointestinal tract is the most common organ system affected by systemic sclerosis (SSc) other than the skin. Greater than 90% of SSc patients have esophageal involvement, which primarily manifests as reflux and dysphagia. In addition to symptoms, complications include stricture, candidal esophagitis, and Barrett’s esophagus. There is an association between esophageal dysmotility and pulmonary disease, although causality has not been established. Gastric involvement is less common and can manifest as dysmotility or bleeding. Gastric dysmotility often presents with impaired gastric emptying and associated symptoms, including nausea, postprandial fullness, bloating, and weight loss. Bleeding is often due to gastric antral vascular ectasia. While this affects a minority of SSc patients, consequences can be significant. This chapter will review the data regarding foregut manifestations and specifically will focus on diagnostic modalities and treatment options including lifestyle modification, medical therapy, alternative therapy, endoscopic modalities, and surgical approaches where appropriate. Unfortunately, treatment remains supportive at present given a general lack of disease-modifying therapies.