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A clinical case of gastrointestinal bleeding in a patient with systemic sclerosis
https://doi.org/10.33667/2078-5631-2025-9-47-52
Abstract
Systemic sclerosis (SS) is a disease with diverse clinical manifestations, with common damage of the gastrointestinal tract (GIT). The traditional description of GIT disorders includes the development of strictures of the lower third of the esophagus due to its scarring with recurrent ulcerative lesions, gastric bleeding due to telangiectasis of the gastric mucosa or ulcerative defects due to ischemia and drug therapy. The development of GIT bleeding is a life-threatening complication of SS. The causes of gastrointestinal bleeding in this category of patients may be both abnormalities of the gastrointestinal mucosa associated with the manifestations of the disease, as well as the effect of basic drug therapy, as well as the presence and treatment of concomitant diseases. In this aspect, early diagnosis of mucosal changes from the digestive tract is a key point in choosing methods for patients monitoring to determine the best tactics of drug therapy, taking into account the benefit/risk ratio while achieving symptom control with improved prognosis. Doctors treating patients with SS should pay attention to the increased risk of gastrointestinal bleeding, especially among patients with comorbid vascular pathology (diabetes mellitus, hypertension, atrial fibrillation), requiring additional use of vasodilators, anticoagulants. Consideration should be given to the endoscopic monitoring of GIT complications among patients with SS, especially those with additional risk factors for damage to the upper GIT, which will useful an appropriate assessment of the risk of bleeding and may ensure timely preventive measures.
About the Authors
N. Yu. Tikhomirova
Kuban State Medical University; Regional clinical Hospital No. 2
Russian Federation
Russian Federation
Nadezhda Yu. Tikhomirova - PhD Med, Associate Professor, Associate Professor at Dept of Faculty Therapy, Kuban State Medical University; rheumatologist at h Rheumatology Center of the SKAL Polyclinic, Regional clinical Hospital No. 2.
Krasnodar
L. N. Eliseeva
Kuban State Medical University
Russian Federation
Russian Federation
Lyudmila N. Eliseeva - DM Sci (habil.), professor, head of Dept of Faculty Therapy.
Krasnodar
N. P. Belozerova
Kuban State Medical University; Regional clinical Hospital No. 2
Russian Federation
Russian Federation
Natalia P. Belozerova - PhD Med, assistant professor of Faculty Therapy, Kuban State Medical University; head of Rheumatology Center of the SKAL Polyclinic, Regional clinical Hospital No. 2.
Krasnodar
E. S. Kameneva
Kuban State Medical University; Regional clinical Hospital No. 2
Russian Federation
Russian Federation
Elena S. Kameneva - PhD Med, assistant at Dept of Polyclinic Therapy with a Course of General Medical Practice (Family Medicine) Faculty of Advanced Training and Professional Retraining of Specialists, Kuban State Medical University; Head of the SKAL Polyclinic, Regional clinical Hospital No. 2.
Krasnodar
M. I. Bocharnikova
Kuban State Medical University
Russian Federation
Russian Federation
Marina I. Bocharnikova - PhD Med, associate professor at Dept of Propaedeutics of Internal Diseases.
Krasnodar
References
1. Johannes WJ Bijlsma. EULAR Texbook on Systemic Sclerosis. 2nd ed. Hachulla E, editor. London: BMJ, 2019. Сriteria for the classification of systemic sclerosis (scleroderma). Subcommittee for scleroderma criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee. Arthritis Rheum. 1980; 23: 581–590. https://doi.org/10.1002/art.1780230510
2. Volkmann ER, Varga J. Emerging targets of disease-modifying therapy for systemic sclerosis. Nat Rev Rheumatol. 2019; 15 (4): 208–24. https://doi.org/10.1038/s41584-019-0184-z
3. Asano Y. Systemic sclerosis. J Dermatol. 2018; 45 (2): 128–38. https://doi.org/10.1111/1346-8138.14153
4. Kuo CF, See LC, Yu KH, Chou IJ, Tseng WY, Chang HC. et al. Epidemiology and mortality of systemic sclerosis: a nationwide population study in Taiwan. Scand J Rheumatol. 2011; 40 (5): 373–8. https://doi.org/10.3109/03009742.2011.553736
5. Rosa JE, Soriano ER, Narvaez-Ponce L, del Cid CC, Imamura PM, Catoggio LJ. Incidence and prevalence of systemic sclerosis in a healthcare plan in Buenos Aires. J Clin Rheumatol. 2011; 17 (2): 59–63. https://doi.org/10.1097/rhu.0b013e31820e7e8d
6. McMahan ZH. Gastrointestinal involvement in systemic sclerosis: an update. Curr Opin Rheumatol. 2019; 31: 561–568. https://doi.org/10.1097/bor.0000000000000645
7. Miller JB, Gandhi N, Clarke J, McMahan Z. Gastrointestinal Involvement in Systemic Sclerosis: An Update. J Clin Rheumatol. 2018; 24: 328–337. https://doi.org/10.1097/rhu.0000000000000626
8. Iglesias-Gamarra A, Jaramillo-Arroyave D, Quintana G, Rondon-Herrera F, Matucci-Cerinic M. Historia del compromiso cutáneo de la esclerosis sistémica. Rev Colomb Reumatol. 2013; 20: 155–170. https://doi.org/10.1016/s0121-8123(13)70128-2
9. Tyndall AJ, Bannert B, Vonk M, Airo P, Cozzi F, Carreira PE. et al. Causes and risk factors for death in systemic sclerosis: a study from the EULAR Scleroderma Trials and Research (EUSTAR) database. Ann Rheum Dis. 2010; 69 (10): 1809–15. https://doi.org/10.1136/ard.2009.114264
10. Duchini A, Sessoms SL. Gastrointestinal hemorrhage in patients with systemic sclerosis and CREST syndrome. Am J Gastroenterol. 1998; 93 (9): 1453–6. https://doi.org/10.1111/j.1572-0241.1998.00462.x
11. Plastiras SC, Tzivras M, Vlachoyiannopoulos PG. Severe gastrointestinal involvement in systemic sclerosis. Clin Rheumatol. 2007; 26 (6): 1025–6. https://doi.org/10.1007/s10067-006-0264-8
12. Ebert EC. Gastric and enteric involvement in progressive systemic sclerosis. J Clin Gastroenterol. 2008; 42 (1): 5–12. https://doi.org/10.1097/mcg.0b013e318042d625
13. Marie I, Antonietti M, Houivet E, Hachulla E, Maunoury V, Bienvenu B, Viennot S, Smail A, Duhaut P, Dupas JL, Dominique S, Hatron PY, Levesque H, Benichou J, Ducrotté P. Gastrointestinal mucosal abnormalities using videocapsule endoscopy in systemic sclerosis. Aliment Pharmacol Ther. 2014; 40: 189–199. https://doi.org/10.1111/apt.12818
14. Lin YT, Chuang YS, Wang JW, Wu PH. High risk of gastrointestinal hemorrhage in patients with systemic sclerosis. Arthritis Res Ther. 2019; 21: 301. https://doi.org/10.1186/s13075-019-2078-5
15. Wielosz E, Borys O, Zychowska I, Majdan M. Gastrointestinal involvement in patients with systemic sclerosis. Polskie Archiwum Medycyny Wewnetrznej. 2010; 120 (4): 132–6. https://doi.org/10.20452/pamw.907
16. Ebert EC. Esophageal disease in scleroderma. J Clin Gastroenterol. 2006; 40 (9): 769–75. https://doi.org/10.1097/01.mcg.0000225549.19127.90
17. Szamosi S, Szekanecz Z, Szucs G. Gastrointestinal manifestations in Hungarian scleroderma patients. Rheumatol Int. 2006; 26 (12): 1120–4. https://doi.org/10.1007/s00296–006–0146-z
18. Ntoumazios SK, Voulgari PV, Potsis K, Koutis E, Tsifetaki N, Assimakopoulos DA. Esophageal involvement in scleroderma: gastroesophageal reflux, the common problem. Semin Arthritis Rheum. 2006; 36 (3): 173–81. https://doi.org/10.1016/j.semarthrit.2006.08.002
19. Marie I, Levesque H, Ducrotte P, Denis P, Hellot MF, Benichou J. et al. Gastric involvement in systemic sclerosis: a prospective study. Am J Gastroenterol. 2001; 96 (1): 77–83. https://doi.org/10.1111/j.1572-0241.2001.03353.x
20. McFarlane IM, Bhamra MS, Kreps A, Iqbal S, Al-Ani F, Saladini-Aponte C, et al. Gastrointestinal manifestations of systemic sclerosis. Rheumatology (Sunnyvale). 2018; 8 (1). https://doi.org/10.4172/2161-1149.1000235
21. Varga J, Trojanowska M, Kuwana M. Pathogenesis of systemic sclerosis: recent insights of molecular and cellular mechanisms and therapeutic opportunities. J Scleroderma Relat Disord. 2017; 2: 137–152. https://doi.org/10.5301/jsrd.5000249
22. Parrado RH, Lemus HN, Coral-Alvarado PX, Quintana López G. Gastric Antral Vascular Ectasia in Systemic Sclerosis: Current Concepts. Int J Rheumatol. 2015; 2015: 762546. https://doi.org/10.1155/2015/762546
23. Ingraham KM, O'Brien MS, Shenin M, Derk CT, Steen VD. Gastric antral vascular ectasia in systemic sclerosis: demographics and disease predictors. J Rheumatol. 2010; 37: 603–607. https://doi.org/10.3899/jrheum.090600
24. Marie I, Ducrotte P, Antonietti M, Herve S, Levesque H. Watermelon stomach in systemic sclerosis: its incidence and management. Aliment Pharmacol Ther. 2008; 28: 412–421. https://doi.org/10.1111/j.1365-2036.2008.03739.x
25. Assad APL, Farias R, Gaspari CN, da Silva HC, Andrade DCO, Sampaio-Barros PD. Diagnosis and Management of Gastric Antral Vascular Ectasia: Experience in a Larg Single Cohort of Patients with Systemic Sclerosis. J Clin Rheumatol. 2020; 26: 79–81. https://doi.org/10.1097/rhu.0000000000000927
26. Kumar S, Singh J, Rattan S, DiMarino AJ, Cohen S, Jimenez SA. Review article: pathogenesis and clinical manifestations of gastrointestinal involvement in systemic sclerosis. Aliment Pharmacol Ther. 2017; 45: 883–898. https://doi.org/10.1111/apt.13963
27. Shibukawa G, Irisawa A, Sakamoto N, Takagi T, Wakatsuki T, Imamura H, Takahashi Y, Sato A, Sato M, Hikichi T, Obara K, Ohira H. Gastric antral vascular ectasia (GAVE) associated with systemic sclerosis: relapse after endoscopic treatment by argon plasma coagulation. Intern Med. 2007; 46: 279–283. https://doi.org/10.2169/internalmedicine.46.6203
28. McCarty TR, Rustagi T. Comparative Effectiveness and Safety of Radiofrequency Ablation versus Argon Plasma Coagulation for Treatment of Gastric Antral Vascular Ectasia: A Systematic Review and Meta-Analysis. J Clin Gastroenterol. 2019; 53: 599–606. https://doi.org/10.1097/mcg.0000000000001088
29. Kirby DF, Chatterjee S. Evaluation and management of gastrointestinal manifestations in scleroderma. Curr Opin Rheumatol. 2014; 26: 621–629. https://doi.org/10.1097/bor.0000000000000117
30. Ananyeva L. P. Treatment of systemic scleroderma based on national recommendations and recommendations of the European League against Rheumatism (EULAR). Pharmaceutical library. 2014; 10: 79–86. EDN SLSVGP.
31. Order 203-n of the Ministry of Health of Russia dated 05/10/2017 N203n «On approval of criteria for assessing the quality of medical care» (registered with the Ministry of Justice of Russia on 05/17/2017, N 46740).
32. Emmanuel A. Current management of the gastrointestinal complications of systemic sclerosis. Nat Rev Gastroenterol Hepatol. 2016; 13: 461–472. https://doi.org/10.1038/nrgastro.2016.99
33. Walker UA, Tyndall A, Czirják L, Denton C, Farge-Bancel D, Kowal-Bielecka O, Müller-Ladner U, Bocelli-Tyndall C, Matucci-Cerinic M. Clinical risk assessment of organ manifestations in systemic sclerosis: a report from the EULAR Scleroderma Trials and Research group database. Ann Rheum Dis. 2007; 66: 754–763. https://doi.org/10.1136/ard.2006.062901
34. Algover-Burri (1967) cited in Limansky V. A. and Rudaev A. Ya. Transfusion therapy in surgical diseases. Moscow, 1984. P. 255.
Review
For citations:
Tikhomirova N.Yu., Eliseeva L.N., Belozerova N.P., Kameneva E.S., Bocharnikova M.I. A clinical case of gastrointestinal bleeding in a patient with systemic sclerosis. Medical alphabet. 2025;(9):47-52. (In Russ.) https://doi.org/10.33667/2078-5631-2025-9-47-52
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