ROENTGENOLOGIC INVESTIGATION OF GASTROINTESTINAL TRACT IN PATIENTS WITH PROGRESSIVE SYSTEMIC SCLEROSIS (PSS)

In order to clarify gastrointestinal involvement in PSS, 59 patients were investigated roentgenologically.The results were as follows : 1) Esophageal abnormalities were observed in 36 out of 59 cases (61.0%), which consisted of diminished peristalsis, aperistalsis, diffuse dilatation, reflux esophagitis and stricture, particularly the last change was observed in 4 cases (6.7%). Colon was involved in 5 out of 18 cases (27.7%), which consisted of diminution or disappearance of haustration, and dilatation. Small intestine showed abnormalities in 7 out of 29 cases (24.1%), which consisted of dilatation, retained barium, sacculation in 1 case and haustration as colon in 2 cases. Duodenal changes were observed in 6 out of 59 cases (10.1%), which consisted of dilatation in 4 cases and ulcer in 2 cases.2) Gastrointestinal symptoms those of heartburn, dysphagia, abdominal pain, diarrhea, constipation, anorexia, etc. were observed in 26 out of 59 cases (44.0%). Among 9 cases with dysphagia, 7 cases (77.7%) showed roentgenologic esophageal abnormality, whereas among 50 cases without dysphagia, only 29 cases (58.0%) showed esophageal change.3) To clarify the relation between skin change and esophageal change, sclerosis of the skin was classified into first, second and third degree, and also roentgenologic esophageal change was classified into 0, I, II, and III stage. In the first degree, 3 out of 10 (30.0%), in the second degree, 26 out of 41 (63.4%), and in the third degree, 7 out of 8 (87.5%), showed esophageal abnormalities respectively.4) Long term observation from 1 to 4 years revealed no improvement of esophageal involvement in 20 cases, namely about a half (11 cases, 55.0%) showed progression, and the rest (9 cases, 45.0%) remained stationary.