Seminars in arthritis and rheumatism · 2026
Systemic sclerosis and small bowel involvement: A systematic review of diagnostic approaches and current evidence.
Систематический обзорСтатьяНазвание и аннотация: Перевод в очереди
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Alcala-Gonzalez Luis G, Felix-Tellez Francisco A, Ayla Ali Y, Guillen-Del-Castillo Alfredo, Simeón-Aznar Carmen P, Hughes Michael, Malagelada Carolina, McMahan Zsuzsanna H
Аннотация
BACKGROUND: Small bowel involvement represents a common and clinically significant manifestation of systemic sclerosis (SSc). Pathogenesis is multifactorial, and diagnosis remains challenging due to non-specific symptoms, limited diagnostic tools, and a lack of standardized management strategies.
METHODS: A systematic search of PubMed and Embase was conducted to identify studies evaluating small bowel involvement in patients with SSc using objective tests and patient tissue. A qualitative synthesis was performed due to the anticipated heterogeneity in study designs, interventions, and outcomes.
RESULTS: Of the 24 studies included, 9 (37.5%) evaluated small bowel motor function using manometry, 12 (50%) employed other objective diagnostic methods, and 7 (29.2%) reported histopathological findings. Manometric studies showed a high prevalence of motor abnormalities: absent or impaired phase III complexes (median 50.3%, IQR,22.5%-81%), reduced phase III migration velocity (31.3%, IQR,18%-53%), diminished contraction amplitude (median 62.5%, IQR,40%-75%), and abnormal postprandial responses (median 60.6%, IQR,50%-90%). No correlation was found between esophageal and small bowel involvement when both were assessed by manometry(5 studies). Transit studies (breath tests, capsule endoscopy, and whole-gut scintigraphy) showed variable performance; however, whole-gut scintigraphy identified clinically relevant associations, including a strong link with increased mortality (HR 4.57; 95% CI: 1.58-13.24). Histopathological results identified smooth muscle atrophy, enteric neuropathy, and vascular fibrosis in the pathogenesis of small bowel involvement.
CONCLUSIONS: In SSc, small bowel involvement is frequent and associated with decreased contractile amplitude and delayed transit time. There is a critical need for standardized diagnostic approaches to enable early recognition and guide management.
METHODS: A systematic search of PubMed and Embase was conducted to identify studies evaluating small bowel involvement in patients with SSc using objective tests and patient tissue. A qualitative synthesis was performed due to the anticipated heterogeneity in study designs, interventions, and outcomes.
RESULTS: Of the 24 studies included, 9 (37.5%) evaluated small bowel motor function using manometry, 12 (50%) employed other objective diagnostic methods, and 7 (29.2%) reported histopathological findings. Manometric studies showed a high prevalence of motor abnormalities: absent or impaired phase III complexes (median 50.3%, IQR,22.5%-81%), reduced phase III migration velocity (31.3%, IQR,18%-53%), diminished contraction amplitude (median 62.5%, IQR,40%-75%), and abnormal postprandial responses (median 60.6%, IQR,50%-90%). No correlation was found between esophageal and small bowel involvement when both were assessed by manometry(5 studies). Transit studies (breath tests, capsule endoscopy, and whole-gut scintigraphy) showed variable performance; however, whole-gut scintigraphy identified clinically relevant associations, including a strong link with increased mortality (HR 4.57; 95% CI: 1.58-13.24). Histopathological results identified smooth muscle atrophy, enteric neuropathy, and vascular fibrosis in the pathogenesis of small bowel involvement.
CONCLUSIONS: In SSc, small bowel involvement is frequent and associated with decreased contractile amplitude and delayed transit time. There is a critical need for standardized diagnostic approaches to enable early recognition and guide management.