Scleroderma

Clinical

Scleroderma is a connective tissue disorder that attacks smooth muscle, causing smooth muscle atrophy and connective tissue replacement. Approximately 90% of patients with scleroderma demontrate GI tract involvement. Clinical manifestations include GERD, esophageal strictures, ad impaired peristalsis throughout the GI tract. Small bowel involvement never precedes skin and esophageal changes.  (Diagnosis is almost always already known when small bowel findings are discovered.)

Radiological

Fluoroscopy is the most sensitive evaluation for small bowel manifestations of scleroderma. Upper GI studies may demonstrate esophageal erosions and strictures. Fuoroscopic findings in the small bowel incude:

• Luminal dilatation.
• “Hidebound appearance” (closely spaced folds, which are normal in thickness).
• Pseudodiverticula (prominent sacculations), most commonly seen in the colon.
• Pseudo-obstruction from hypomotility with prolonged transit time.

Diagram demonstrating the various fluoroscopic presenteations of scleroderma.