Preview

Современная ревматология

Расширенный поиск

Поражение желудочно-кишечного тракта при системной склеродермии

https://doi.org/10.14412/1996-7012-2026-2-72-77

Аннотация

Системная склеродермия (ССД) – хроническое аутоиммунное заболевание, которое характеризуется генерализованной микроангиопатией, фиброзом кожи и внутренних органов. Желудочно-кишечный тракт (ЖКТ) является наиболее часто поражаемой системой органов при ССД, а признаки вовлечения ЖКТ нередко возникают на ранних стадиях заболевания. В настоящее время одобренные варианты лечения поражений ЖКТ при ССД ограничены, при этом подходы к лечению патологии разных отделов ЖКТ имеют принципиальные различия. Несмотря на высокую распространенность, гастроэнтерологические осложнения ССД недостаточно освещены в литературе. В обзоре проанализированы современные методы диагностики и лечения поражений ЖКТ при ССД 

Об авторе

Р. Т. Алекперов
ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского»
Россия

Ризван Таир оглы Алекперов

129110, Москва, ул. Щепкина, 61/2 



Литература

1. Forbes A, Marie I. Gastrointestinal complications: the most frequent internal complications of systemic sclerosis. Rheumatology (Oxford). 2009 Jun:48 Suppl 3:iii36-9. doi: 10.1093/rheumatology/ken485.

2. Poudel DR, Jayakumar D, Danve A, et al. Determinants of mortality in systemic sclerosis: a focused review. Rheumatol Int. 2018 Oct; 38(10):1847-1858. doi: 10.1007/s00296-017-3826-y.

3. von Mühlenbrock C, Madrid AM, Defilippi C, et al. Diffuse Gastrointestinal Motor Compromise in Patients with Scleroderma: Utility of Minimally Invasive Techniques. Dig Dis Sci. 2024 Jan;69(1):191-199. doi: 10.1007/s10620-023-08151-5.

4. Volkmann ER, McMahan Z. Gastrointestinal involvement in systemic sclerosis: Pathogenesis, assessment, and treatment. Curr Opin Rheumatol. 2022 Nov 1;34(6):328-336. doi: 10.1097/BOR.0000000000000899.

5. Jimenez SA, Mendoza FA, Piera Velazquez S. A review of recent studies on the pathogenesis of Systemic Sclerosis: focus on fibrosis pathways. Front Immunol. 2025 Apr 16:16: 1551911. doi: 10.3389/fimmu.2025.1551911.

6. Kumar S, Singh J, Rattan S, et al. Review article: pathogenesis and clinical manifestations of gastrointestinal involvement in systemic sclerosis. Aliment Pharmacol Ther. 2017 Apr;45(7):883-898. doi: 10.1111/apt.13963.

7. Tian XP, Zhang X. Gastrointestinal complications of systemic sclerosis. World J Gastroenterol. 2013 Nov 7;19(41):7062-8. doi: 10.3748/wjg.v19.i41.7062.

8. Kumar S, Singh J, Kedika R, et al. Role of muscarinic-3 receptor antibody in systemic sclerosis: correlation with disease duration and effects of IVIG. Am J Physiol Gastrointest Liver Physiol. 2016 Jun 1;310(11):G1052-60. doi: 10.1152/ajpgi.00034.2016.

9. Ayla AY, Kalavar NR, Pimentel M, et al. Anti-muscarinic 3 antibodies associate with a severe clinical phenotype in patients with systemic sclerosis. Rheumatology (Oxford). 2025 Oct 1;64(10):5230-5237. doi: 10.1093/ rheumatology/keaf197.

10. Bixio R, Bertelle D, Bertoldo E, et al. The potential pathogenic role of gut microbiota in rheumatic diseases: a human-centred narrative review. Intern Emerg Med. 2024 Jun; 19(4):891-900. doi: 10.1007/s11739-023-03496-1.

11. Thonhofer R, Siegel C, Trummer M, Graninger W. Early endoscopy in systemic sclerosis without gastrointestinal symptoms. Rheumatol Int. 2012 Jan;32(1):165-8. doi: 10.1007/s00296-010-1595-y.

12. Salaffi F, Di Carlo M, Carotti M, et al. Relationship between interstitial lung disease and oesophageal dilatation on chest high-resolution computed tomography in patients with systemic sclerosis: a cross-sectional study. Radiol Med. 2018 Sep;123(9):655-663. doi: 10.1007/s11547-018-0894-3.

13. McFarlane IM, Bhamra MS, Kreps A, et al. Gastrointestinal manifestations of systemic sclerosis. Rheumatology (Sunnyvale). 2018;8(1):235. doi: 10.4172/2161-1149.1000235.

14. Snyder DL, Crowell MD, Kahn A, et al. Prevalence of Barrett’s Esophagus in Female Patients With Scleroderma. Am J Gastroenterol. 2021 Mar 1;116(3):517-521. doi: 10.14309/ajg.0000000000001109.

15. Rutka K, Galkowski A, Karaszewska K, Lebkowska U. Imaging in Diagnosis of Systemic Sclerosis. J Clin Med. 2021 Jan 12; 10(2):248. doi: 10.3390/jcm10020248.

16. Khanna D, Nagaraja V, Gladue H, et al. Measuring response in the gastrointestinal tract in systemic sclerosis. Curr Opin Rheumatol. 2013 Nov;25(6):700-6. doi: 10.1097/01.bor.0000434668.32150.e5.

17. Zentilin P, Savarino V, Marabotto E, et al. Esophageal baseline impedance levels allow the identification of esophageal involvement in patients with systemic sclerosis. Semin Arthritis Rheum. 2018 Feb;47(4):569-574. doi: 10.1016/j.semarthrit.2017.08.004.

18. Del Galdo F, Lescoat A, Conaghan PG, et al. EULAR recommendations for the treatment of systemic sclerosis: 2023 update. Ann Rheum Dis. 2025 Jan;84(1):29-40. doi: 10.1136/ard-2024-226430.

19. Shirai Y, Kawami N, Iwakiri K, Kuwana M. Use of vonoprazan, a novel potassiumcompetitive acid blocker, for the treatment of proton pump inhibitor-refractory reflux esophagitis in patients with systemic sclerosis. J Scleroderma Relat Disord. 2022 Feb;7(1): 57-61. doi: 10.1177/23971983211021747.

20. Foocharoen C, Chunlertrith K, Mairiang P, et al. Effectiveness of add-on therapy with domperidone vs alginic acid in proton pump inhibitor partial response gastro-oesophageal reflux disease in systemic sclerosis: randomized placebo-controlled trial. Rheumatology (Oxford). 2017 Feb;56(2):214-222. doi: 10.1093/rheumatology/kew216.

21. Scheerens C, Tack J, Rommel N. Buspirone, a new drug for the management of patients with ineffective esophageal motility. United European Gastroenterol J. 2015 Jun;3(3): 261-5. doi: 10.1177/2050640615585688.

22. Karamanolis GP, Panopoulos S, Denaxas K, et al. The 5-HT1A receptor agonist buspirone improves esophageal motor function and symptoms in systemic sclerosis: a 4-week, open-label trial. Arthritis Res Ther. 2016 Sep 1;18(1):195. doi: 10.1186/s13075-016-1094-y.

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 Jul; 93(7):1085-9. doi: 10.1111/j.1572-0241.1998.00334.x.

24. Marie I, Ducrotte P, Antonietti M, et al. Watermelon stomach in systemic sclerosis: its incidence and management. Aliment Pharmacol Ther. 2008 Aug 15;28(4):412-21. doi: 10.1111/j.1365-2036.2008.03739.x.

25. Sallam H, McNearney TA, Chen JD. Systematic review: pathophysiology and management of gastrointestinal dysmotility in systemic sclerosis (scleroderma). Aliment Pharmacol Ther. 2006 Mar 15;23(6):691-712. doi: 10.1111/j.1365-2036.2006.02804.x.

26. Grover M, Farrugia G, Stanghellini V. Gastroparesis: a turning point in understanding and treatment. Gut. 2019 Dec;68(12): 2238-2250. doi: 10.1136/gutjnl-2019-318712.

27. Camilleri M. Functional Dyspepsia and Gastroparesis. Dig Dis. 2016;34(5):491-9. doi: 10.1159/000445226.

28. Carbone F, Van den Houte K, Clevers E, et al. Prucalopride in gastroparesis: a randomized placebo-controlled crossover study. Am J Gastroenterol. 2019 Aug;114(8):1265-1274. doi: 10.14309/ajg.0000000000000304.

29. Vigone B, Caronni M, Severino A, et al. Preliminary safety and efficacy profile of prucalopride in the treatment of systemic sclerosis (SSc)-related intestinal involvement: results from the open label cross-over PROGASS study. Arthritis Res Ther. 2017 Jun 20;19(1): 145. doi: 10.1186/s13075-017-1340-y.

30. Polkowska-Pruszynska B, Gerkowicz A, Szczepanik-Kulak P, Krasowska D. Small intestinal bacterial overgrowth in systemic sclerosis: a review of the literature. Arch Dermatol Res. 2019 Jan;311(1):1-8. doi: 10.1007/s00403-018-1874-0.

31. Sattar B, Chokshi RV. Colonic and anorectal manifestations of systemic sclerosis. Curr Gastroenterol Rep. 2019 Jul 8;21(7):33. doi: 10.1007/s11894-019-0699-0.

32. Marie I, Ducrotte P, Denis P, et al. Outcome of small-bowel motor impairment in systemic sclerosis – a prospective manometric 5-yr follow-up. Rheumatology (Oxford). 2007 Jan;46(1):150-3. doi: 10.1093/rheumatology/kel203.

33. Kaneko M, Sasaki S, Teruya S, et al. Pneumatosis Cystoides Intestinalis in Patients with Systemic Sclerosis: A Case Report and Review of 39 Japanese Cases. Case Rep Gastrointest Med. 2016:2016:2474515. doi: 10.1155/2016/2474515.

34. Brandler JB, Sweetser S, Khoshbin K, et al. Colonic manifestations and complications are relatively under-reported in systemic sclerosis: a systematic review. Am J Gastroenterol. 2019 Dec;114(12):1847-1856. doi: 10.14309/ajg.0000000000000397.

35. Kaniecki T, Abdi T, McMahan ZH. Clinical Assessment of Gastrointestinal Involvement in Patients with Systemic Sclerosis. Med Res Arch. 2020 Oct;8(10):2252. doi: 10.18103/mra.v8i10.2252.

36. Marie I, Ducrotte P, Denis P, et al. Small intestinal bacterial overgrowth in systemic sclerosis. Rheumatology (Oxford). 2009 Oct; 48(10):1314-9. doi: 10.1093/rheumatology/kep226.

37. Tan TC, Chandrasekaran L, Leung YY, et al. Gut microbiome profiling in systemic sclerosis: a metagenomic approach. Clin Exp Rheumatol. 2023 Aug;41(8):1578-1588. doi: 10.55563/clinexprheumatol/jof7nx.

38. Pittman N, Rawn SM, Wang M, et al. Treatment of small intestinal bacterial overgrowth in systemic sclerosis: a systematic review. Rheumatology (Oxford). 2018 Oct 1; 57(10):1802-1811. doi: 10.1093/rheumatology/key175.

39. Polkowska-Pruszynska B, Gerkowicz A, Rawicz-Pruszynski K, Krasowska D. Gut microbiome in systemic sclerosis: a potential therapeutic target. Postepy Dermatol Alergol. 2022 Feb;39(1):101-109. doi: 10.5114/ada.2020.101468.

40. Quigley EMM. The spectrum of small intestinal bacterial overgrowth (SIBO). Curr Gastroenterol Rep. 2019 Jan 15;21(1):3. doi: 10.1007/s11894-019-0671-z.

41. Erdogan A, Rao SS, Gulley D, et al. Small intestinal bacte rial overgrowth: duodenal aspiration vs glucose breath test. Neurogastroenterol Motil. 2015 Apr;27(4):481-9. doi: 10.1111/nmo.12516.

42. Ohkubo H, Kessoku T, Tanaka K, et al. Efficacy and safety of rifaximin in patients with chronic intestinal pseudo-obstruction: a randomized, double-blind, placebo-controlled, phase II — a exploratory trial. Biosci Microbiota Food Health. 2024;43(2):135-144. doi: 10.12938/bmfh.2023-080.

43. Ahuja NK, Mische L, Clarke JO, et al. Pyridostigmine for the treatment of gastrointestinal symptoms in systemic sclerosis. Semin Arthritis Rheum. 2018 Aug;48(1):111-116. doi: 10.1016/j.semarthrit.2017.12.007.

44. Fretheim H, Chung BK, Didriksen H, et al. Fecal microbiota transplantation in systemic sclerosis: a double-blind, placebo-controlled randomized pilot trial. PLoS One. 2020 May 21;15(5):e0232739. doi: 10.1371/journal.pone.0232739.

45. Garcia-Collinot G, Madrigal-Santillan EO, Martinez-Bencomo MA, et al. Effectiveness of saccharomyces boulardii and metronidazole for small intestinal bacterial overgrowth in systemic sclerosis. Dig Dis Sci. 2020 Apr; 65(4):1134-1143. doi: 10.1007/s10620-019-05830-0.

46. Fynne L, Worsoe J, Gregersen T, et al. Gastrointestinal transit in patients with systemic sclerosis. Scand J Gastroenterol. 2011 Oct;46(10):1187-93. doi: 10.3109/00365521.2011.603158.

47. D’Angelo G, Stern HS, Myers E. Rectal prolapse in scleroderma: case report and review of the colonic complications of scleroderma. Can J Surg. 1985 Jan;28(1):62-3.

48. Dein E, Kuo PL, Hong YS, et al. Evaluation of risk factors for pseudo-obstruction in systemic sclerosis. Semin Arthritis Rheum. 2019 Dec;49(3):405-410. doi: 10.1016/j.semarthrit.2019.05.005.

49. Valenzuela A, Li S, Becker L, et al. Intestinal pseudo-obstruction in patients with systemic sclerosis: an analysis of the Nationwide Inpatient Sample. Rheumatology (Oxford). 2016 Apr;55(4):654-8. doi: 10.1093/rheumatology/kev393.

50. Boeckxstaens GE, Bartelsman LL, Tytgat GN. Treatment of GI dysmotility in scleroderma with the new enterokinetic agent prucalopride. Am J Gastroenterol. 2002 Jan; 97(1):194-7. doi: 10.1111/j.1572-0241.2002. 05396.x.

51. Garros A, Marjoux S, Khouatra C, et al. Prevalence of fecal incontinence in a cohort of systemic sclerosis patients within a regional referral network. United European Gastroenterol J. 2017 Nov;5(7):1046-1050. doi: 10.1177/2050640616688129.

52. Kenefick NJ, Vaizey CJ, Nicholls RJ, et al. Sacral nerve stimulation for faecal incontinence due to systemic sclerosis. Gut. 2002 Dec; 51(6):881-3. doi: 10.1136/gut.51.6.881.

53. Butt SK, Alam A, Cohen R, et al. Lack of effect of sacral nerve stimulation for incontinence in patients with systemic sclerosis. Colorectal Dis. 2015 Oct;17(10):903-7. doi: 10.1111/codi.12969.

54. Al Asari S, Meurette G, Mantoo S, et al. Percutaneous tibial nerve stimulation vs sacral nerve stimulation for faecal incontinence: a comparative case-matched study. Colorectal Dis. 2014 Nov;16(11):O393-9. doi: 10.1111/codi.12680.


Рецензия

Для цитирования:


Алекперов РТ. Поражение желудочно-кишечного тракта при системной склеродермии. Современная ревматология. 2026;20(3):72-78. https://doi.org/10.14412/1996-7012-2026-2-72-77

For citation:


Alekperov RT. Gastrointestinal tract involvement in systemic sclerosis. Sovremennaya Revmatologiya=Modern Rheumatology Journal. 2026;20(3):72-78. (In Russ.) https://doi.org/10.14412/1996-7012-2026-2-72-77

Просмотров: 174

JATS XML


Creative Commons License
Контент доступен под лицензией Creative Commons Attribution 4.0 License.


ISSN 1996-7012 (Print)
ISSN 2310-158X (Online)