Gastrointestinal Manifestations of Systemic Sclerosis

Case Report

Figure 1 · Endoscopic findings

Clinical History

A 48-year-old woman with known systemic sclerosis was referred for malignancy screening. She reported dyspepsia and abdominal bloating. Her medications included mycophenolate mofetil. On clinical examination, her abdomen was slightly distended and tympanitic but non-tender. The indication for endoscopy was malignancy screening and evaluation of her gastrointestinal symptoms.

Endoscopic Findings

1. Esophageal motility disorder and dilation with retained saliva.
2. Markedly dilated duodenum with wide separation between Kerckring folds.
3. Markedly dilated terminal ileum on colonoscopy.

Endoscopic Technique

Standard esophagogastroduodenoscopy and colonoscopy with terminal ileum intubation were performed for malignancy screening and symptom evaluation. No therapeutic intervention was required during this diagnostic examination.

Discussion

Mechanism. Systemic sclerosis, or scleroderma, is characterized by widespread collagen deposition, resulting in tissue and organ fibrosis. Most patients experience gastrointestinal manifestations, including esophageal dysmotility, gastroparesis, megaduodenum, small bowel diverticulosis, and chronic intestinal pseudo-obstruction. The gastrointestinal abnormalities are likely a consequence of muscular atrophy and collagen replacement of the outer longitudinal layer relative to the inner circular layer. Small intestinal involvement can lead to delayed transit, dilation of small bowel loops, and secondary bacterial overgrowth.

What the scope shows. In this patient, the endoscopic triad of esophageal dilation with retained secretions, megaduodenum, and mega ileum illustrates how scleroderma can remodel multiple GI segments at once.

Why it matters. Recognition matters because these findings explain common symptoms such as dyspepsia and bloating, and they raise the possibility of bacterial overgrowth when dilated loops impair clearance.