Gastrointestinal Manifestations in Patients with Progressive Systemic Sclerosis:Measurements on Small Intestinal Radiograph Keishi Kawakubo 1 , Mitsuo Iida 1 , Shuji Tada 1 1The Second Department of Internal Medicine, Faculty of Medicine, Kyushu University Keyword: 進行性全身性硬化症(PSS) , 小腸X線像 , 二重造影法 pp.1223-1233
Published Date 1991/11/25
DOI https://doi.org/10.11477/mf.1403102683
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 Twelve patients with progressive systemic sclerosis (PSS) were reviewed to study the characteristic features of gastrointestinal involvement, especially of the small intestine. The examinations included single-contrast or double-contrast radiography and endoscopy of the esophagus, stomach, duodenum, small intestine, and colon.

 Dilatation of the esophagus, duodenum and jejunum was detected by barium meal study in half of the twelve patients, whereas the stomach was not radiographically or endoscopically affected in any patient. Barium enema examination revealed diminution or disappearance of colonic haustration in five out of eleven patients studied. In patients with PSS, the caliber of the jejunal lumen was larger and the intervalvular distance was smaller than that in normal controls respectively, while the valvular width was not significantly different between the PSS and control groups. In addition, double-contrast study of the small intestine was more useful than barium meal study to detect dilated caliber of the jejunal lumen and shortened intervalvular distance. In five patients, follow-up small intestinal examinations demonstrated the progression of the dilatation of the jejunal caliber, the shortening of intervalvular distance, and the increase in valvular width. Histological examination of the autopsy specimen in one patient, whose esophgeal and small intestinal dilatation had been confirmed while alive, revealed loss or disappearance of the muscular layer, accompanied by deposition of the collagen fibers and submucosal infiltration of mononuclear cells throughout the alimentary tract. In addition, the proper muscle, especially the inner circular layer, of the duodenum and the jejunum was more severely affected.

 These results suggest that PSS affects the small intestine more frequently than previously described, and also that the jejunal dilatation with the shortened intervalvular distance on radiograph is a diagnotic finding for PSS.

Copyright © 1991, Igaku-Shoin Ltd. All rights reserved.


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