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Resumen
En la esclerosis sistémica, el esófago se afecta en un 90%, seguido de los tramos anorrectal (50-70%), gástrico (40- 70%), colon (10-50%) e intestino delgado (40%). Las manifestaciones esofágicas son la disfagia, el reflujo gastroesofágico y sus complicaciones. Las alteraciones gástricas son consecuencia de la gastroparesia (náuseas, plenitud posprandial, entre otras). La afección intestinal produce hipomotilidad (distensión abdominal, absorción intestinal deficiente, sobrecrecimiento bacteriano, seudoobstrucción intestinal). A nivel de colon hay divertículos, constipación intestinal e incontinencia fecal. Para el diagnóstico son útiles los estudios con medio de contraste, la endoscopia del tubo digestivo superior, vaciamiento gástrico, pH-metría, manometría esofágica y rectal, así como estudios para investigar el síndrome de absorción intestinal deficiente. Los procinéticos son fundamentales en el tratamiento de las manifestaciones de hipomotilidad del tubo digestivo, aunados con los inhibidores de la bomba de protones en casos de trastornos esofágicos y los antibióticos si hay sobrecrecimiento bacteriano.
Palabras clave:
Esclerosis sistémica
Tracto gastrointestinal
Manifestaciones clínicas
Diagnóstico
Tratamiento
In systemic sclerosis esophagus is affected in 90% followed by anal and rectal involvement (50-70%), stomach (40-70%), colon (10-50%) and small bowel (40%). The main clinical findings are esophagic: dysphagia and sign of gastroesophageal reflux and its complications. Gastric symptomatology is a consequence of gastroparesis (postprandial fullness, nausea). Intestinal affection produces hypomotility (abdominal distention, deficient intestinal absorption, bacterial overgrowth). In colon there are diverticula, intestinal constipation, and fecal incontinence. For the diagnosis of GIT involvement the following are useful: studies of digestive tract with contrast media, endoscopy of upper GIT; gastric emptying; pH metry; esophageal and rectal manometry, as well as test to investigate deficient intestinal absorption syndrome. The prokinetic are a cornerstone for the treatment of hypomotility of GIT, along with pump proton inhibitors for the esophageal alteration and antibiotics for bacterial overgrowth.
Key words:
Systemic sclerosis
Gastrointestinal tract
Clinical manifestation
Diagnosis
Treatment
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