Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 457

The peak incidence of progressive systemic sclerosis is in the fifth and sixth decades. Gastrointestinal involvement occurs in a majority, affecting multiple regions of the gut, although the correlation between histological involvement and symptoms may be weak.⁷¹ Oesophageal dysmotility has a prevalence of about 80%, with diminished amplitude of pressure waves and sometimes a lack of peristalsis in the distal (smooth muscle) oesophagus, leading to impaired acid clearance and severe reflux disease. LOS resting pressure also tends to be extremely low. Furthermore, the stomach, small and large intestines, and anorectum may be involved, with clinical manifestations of gastroparesis, pseudo‐obstruction, bacterial overgrowth (sometimes associated with small‐intestinal diverticula), malnutrition, and constipation or faecal incontinence. While smooth muscle atrophy and fibrosis underlie some of these disturbances,⁷² inhibition of cholinergic transmission in the enteric nervous system by antibodies to M3 muscarinic receptors may be important in the pathogenesis. Similar effects on gastrointestinal motility may be seen in other connective tissue disorders and amyloidosis. PPIs are effective in the treatment of GORD, although high‐dose therapy may be needed. The role of surgery in refractory reflux symptoms is controversial, but good results can be achieved.⁷³ Prokinetic drugs have a role when gastrointestinal transit is delayed.