Highlights
- •Very little is available for early screening and diagnosis of bowel vasculopathy in SSc.
- •CDU can demonstrate impedance and elasticity impairment of splanchnic vessels in SSc.
- •SMA and IMA CDU may support a therapeutic approach targeted on early SSc involvement of splanchnic circulation.
Abstract
Background
Gastrointestinal (GI) manifestations are frequent in systemic sclerosis (SSc) with
an impact on quality of life and morbidity. Bowel vasculopathy is a key pathogenetic
factor responsible for GI involvement.
Objectives
To compare abdominal ultrasound (US) and Color Doppler Ultrasonography (CDU) features
of splanchnic vessels of SSc patients with healthy controls.
Methods
The charts of SSc patients who underwent an abdominal US and CDU study were retrospectively
analyzed. For Superior Mesenteric Artery (SMA) and Inferior Mesenteric Artery (IMA)
caliber, Peak Systolic Velocity (PSV), Reverse Velocity (RV), End-Diastolic Velocity
(EDV), Mean Velocity (mV), Blood-flow, Resistive Index (RI) and Pulsatility Index
(PI) were recorded.
Results
28 SSc patients and 28 controls were enrolled. In SSc, caliber of SMA was significantly
smaller than in controls (5.75 ± 0.62 mm vs. 6.45 ± 0.60 mm, p < 0.0001 – p adj =0.0002). The flow study of SMA and IMA showed a significant reduction
of RV (SMA: 7.25 ± 6.37 cm/s vs. 18.52 ± 6.16 cm/s, p < 0.0001 - p adj <0.0001; IMA: 2.69 ± 6.10 cm/s vs. 17.06 ± 5.75 cm/s, p < 0.0001 - p adj <0.0001) and PI (SMA: 3.33 ± 0.75 vs. 4.53 ± 1.03, p < 0.0001 - p adj =0.0002; IMA: 3.54 ± 0.95 vs. 6.08 ± 1.53, p < 0.0001 - p adj <0.0001) in SSc patients than controls.
Conclusion
involvement of splanchnic vessels in SSc may be non-invasively investigated with abdominal
US and CDU. Morphological and functional changes of Doppler parameters observed in
SMA and IMA clearly demonstrate that these vessels are affected by SSc vasculopathy.
Keywords
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References
- Scleroderma.N Engl J Med. 2009; 360: 1989-2003
- Review: Evidence that systemic sclerosis is a vascular disease.Arthritis Rheuma. 2013; 65: 1953-1962
- Gastrointestinal features of scleroderma.Curr Opin Rheumatol. 1996; 8: 569-575
- Gastric and enteric involvement in progressive systemic sclerosis.J Clin Gastroenterol. 2008; 42: 5-12
- Sclerodermatous involvement of the stomach and the small and large bowel.Gut. 1969; 10: 285-292
- Gastrointestinal manifestations of systemic sclerosis.Rheumatol Curr Res. 2018; 08: 235
- Gastrointestinal manifestations of systemic sclerosis.J Scleroderma Relat Dis. 2016; 1: 247-256
- Predictors of survival in systemic sclerosis (Scleroderma).Arthritis Rheum. 1991; 34: 403-413
- Gastrointestinal involvement in systemic sclerosis: an update.Curr Opin Rheumatol. 2019; 31: 561-568
- Decreased coronary reserve in primary scleroderma myocardial disease.Arthritis Rheum. 1985; 28: 637-646
- Lack of activation of renal functional reserve predicts the risk of significant renal involvement in systemic sclerosis.Ann Rheum Dis. 2011; 70: 1963-1967
- Exercise doppler echocardiography identifies preclinic asymptomatic pulmonary hypertension in systemic sclerosis.Ann N Y Acad Sci. 2007; 1108: 291-304
- Standardization of the modified Rodnan skin score for use in clinical trials of systemic sclerosis.J Scleroderma Relat Disord. 2017; 2: 11-18
- Capillary alterations in scleroderma.J Am Acad Dermatol. 1980; 2: 161-170
- Ischaemia of the small intestine in patients with systemic sclerosis: Raynaud's phenomenon or chronic vasculopathy?.QJM An Int J Med. 1994; 87: 495-500
- Small intestinal bacterial overgrowth in systemic sclerosis.J Scleroderma Relat Disord. 2020; 5: 33-39
- Small bowel bacterial overgrowth in systemic sclerosis: detection using direct and indirect methods and treatment outcome.Rheumatology. 1995; 34 (Oxford): 265-269
- Radiological findings in gastrointestinal scleroderma.J Scleroderma Relat Disord. 2019; : 21-32https://doi.org/10.1177/2397198319848550
- EFSUMB recommendations and guidelines for gastrointestinal ultrasound - part 1: examination techniques and normal findings (long version).Ultraschall der Med Eur J Ultrasound. 2017; 38: e1-e15
- Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn's disease.Aliment Pharmacol Ther. 2011; 34: 125-145
- Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines.J Crohn's Colitis. 2013; 7: 556-585
- Doppler sonography of the superior mesenteric artery in Crohn's disease.Am J Roentgenol. 1998; 170: 123-126
- Doppler sonography of hemodynamic changes of the inferior mesenteric artery in inflammatory bowel disease: preliminary data.Am J Roentgenol. 1999; 173: 381-387
- Sonographic assessment of splanchnic arteries and the bowel wall.Eur J Radiol. 2007; 64: 202-212
- Duplex sonography of the mesenteric vessels – a critical evaluation of inter observer variability.Z Gastroenterol. 2016; 54: 304-311https://doi.org/10.1055/s-0041-107544
- Factors affecting splanchnic haemodynamics in Crohn's disease: a prospective controlled study using Doppler ultrasound.Gut. 1998; 43: 645-650
- Review article: pathogenesis and clinical manifestations of gastrointestinal involvement in systemic sclerosis.Aliment Pharmacol Ther. 2017; 45: 883-898
- A disease severity scale for systemic sclerosis: development and testing.J Rheumatol. 1999; 26: 2159-2167
- Disease severity of 100 patients with systemic sclerosis over a period of 14 years: using a modified Medsger scale.Ann Rheum Dis. 2001; 60: 1117-1122
- Gastrointestinal motility disorders in scleroderma.Arthritis Rheum. 1994; 37: 1265-1282
- Severe gastrointestinal involvement in systemic sclerosis: report of five cases and review of the literature.Semin Arthritis Rheum. 2005; 34: 689-702
- Gastrointestinal involvement in systemic sclerosis: effects on morbidity and mortality and new therapeutic approaches.J Scleroderma Relat Disord. 2019; 20: 1-7
- Gastrointestinal manifestation of systemic sclerosis—thickening of the upper gastrointestinal wall detected by endoscopic ultrasound is a valid sign.Rheumatology. 2010; 49 (Oxford): 368-372
- Endoscopic detection of ischaemia with a new probe indicates low oxygenation of gastric epithelium in portal hypertensive gastropathy.Gut. 1995; 36: 654-656
- Ultrastructural study of the muscle coat of the gastric wall in a case of systemic sclerosis.Ann Rheum Dis. 2002; 61: 754-756
- Idiopathic portal hypertension complicating systemic sclerosis: a case report.BMC Gastroenterol. 2005; 5: 16
- Iloprost enhances portal flow velocity and volume in patients with systemic sclerosis.In Vivo. 2006; 20: 377-380
- Hemodynamic effects of a prostacyclin analog (Prostavasin) in systemic scleroderma patients.Radiol Med. 2005; 110: 106-10614
- Superior mesenteric artery blood flow in systemic sclerosis patients.Rheumatology. 2002; 41 (Oxford): 730-734
Article info
Publication history
Published online: January 17, 2022
Accepted:
January 13,
2022
Received in revised form:
January 5,
2022
Received:
November 19,
2021
Footnotes
☆The members of the Study Group of Rheumathology and Internal Medicine are listed in the Appendix
Identification
Copyright
© 2022 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
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- Ultrasound evaluation of bowel vasculopathy in systemic sclerosis but…European Journal of Internal MedicineVol. 100
- PreviewThe gastrointestinal (GI) tract is affected in up to 90% of patients with systemic sclerosis (SSc). SSc is a key contributor to impairment and disability, leading to remarkable abnormal social functioning and impaired quality of life [1,2], and it is one of the leading causes of death in the past decades [3].
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