Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA.
Clin Transl Gastroenterol. 2020 Aug;11(8):e00206. doi: 10.14309/ctg.0000000000000206.
Intestinal pseudo-obstruction is characterized by impaired transit and luminal dilation in the absence of mechanical obstruction. Our study aims to describe the clinical, radiographic, and physiological findings in pseudo-obstruction associated with systemic sclerosis (SSc), amyloidosis, and paraneoplastic syndrome.
A retrospective cohort of patients evaluated at our institution between January 1, 2008, and August 1, 2018, was assembled. Clinical, imaging, and physiological characteristics were abstracted from electronic medical records.
We identified 100 cases of pseudo-obstruction (55 SSc, 27 amyloidosis, and 18 paraneoplastic). Female population predominance was seen in SSc (71%) vs male population in amyloidosis (74%). Most common symptom was abdominal bloating in all 3 groups. Vomiting was more common in SSc than amyloidosis (73% vs 46%, P = 0.02). Diarrhea was more common in amyloidosis and SSc compared with paraneoplastic (81% and 67% vs 28%, P < 0.01). Weight loss (>5%) was more common in SSc compared with amyloidosis and paraneoplastic (78% vs 31% and 17%, P < 0.0001). Only small bowel dilation was seen in 79%, 40%, and 44% and only large bowel dilation in 2%, 44%, and 44% of patients in SSc, amyloidosis, and paraneoplastic, respectively. Five of 8 SSc patients had myopathic and 3 of 5 paraneoplastic had neuropathic involvement on gastroduodenal manometry.
SSc-associated pseudo-obstruction demonstrates female population predominance and presents with vomiting, diarrhea, and weight loss. Amyloidosis-associated pseudo-obstruction shows male population predominance. Small bowel is more commonly involved than large bowel on both imaging and transit studies in SSc. Myopathic involvement was more common in SSc, contrary to neuropathic in paraneoplastic syndrome.
肠假性梗阻的特征是在不存在机械梗阻的情况下，转运和管腔扩张受损。我们的研究旨在描述与系统性硬化症（SSc）、淀粉样变性和副肿瘤综合征相关的假性梗阻的临床、影像学和生理学发现。
我们组建了一个回顾性队列，纳入了 2008 年 1 月 1 日至 2018 年 8 月 1 日期间在我们机构接受评估的患者。从电子病历中提取临床、影像学和生理学特征。
我们确定了 100 例假性梗阻病例（55 例 SSc、27 例淀粉样变性和 18 例副肿瘤）。SSc 中女性患者居多（71%），而淀粉样变性中男性患者居多（74%）。所有 3 组最常见的症状都是腹部胀气。呕吐在 SSc 中比在淀粉样变性中更常见（73% vs 46%，P=0.02）。腹泻在淀粉样变性和 SSc 中比在副肿瘤中更常见（81%和 67% vs 28%，P<0.01）。体重减轻（>5%）在 SSc 中比在淀粉样变性和副肿瘤中更常见（78% vs 31%和 17%，P<0.0001）。只有 79%、40%和 44%的患者仅显示小肠扩张，只有 2%、44%和 44%的患者仅显示大肠扩张。8 例 SSc 患者中有 5 例存在肌病，5 例副肿瘤中有 3 例存在神经病变。
SSc 相关的假性梗阻表现为女性患者居多，表现为呕吐、腹泻和体重减轻。淀粉样变性相关的假性梗阻表现为男性患者居多。影像学和转运研究均显示，小肠比大肠更常受累。SSc 中更常见的是肌病，而副肿瘤中则更常见的是神经病。
