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SSc GI Telangiectasia — SCE Rheumatology MCQ

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ModerateSystemic SclerosisSSc GI TelangiectasiaSCE Rheumatology

A 50-year-old woman with limited cutaneous systemic sclerosis has extensive telangiectases on her face, hands and lips. She has persistent iron-deficiency anaemia without overt gastrointestinal bleeding and takes no NSAID, antiplatelet or anticoagulant drugs. Oesophagogastroduodenoscopy shows neither peptic ulceration nor gastric antral vascular ectasia, and colonoscopy is normal. Which lesion is the most likely cause of her ongoing occult blood loss?

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Correct answer: C — Small-bowel mucosal telangiectases

The correct answer is C. Systemic sclerosis vasculopathy can produce mucosal telangiectases throughout the gastrointestinal tract, distinct from gastric antral vascular ectasia. Small-bowel lesions may ooze chronically and cause otherwise unexplained iron-deficiency anaemia; capsule endoscopy or enteroscopy may be required after normal conventional endoscopy. Extensive cutaneous telangiectasia strengthens this association. Crohn disease would usually have additional inflammatory or gastrointestinal features. NSAID enteropathy is contradicted by the medication history. Meckel diverticulum is an uncommon presentation at this age and more often produces overt bleeding. Small-bowel adenocarcinoma remains a generic differential diagnosis but is less specifically suggested by the SSc vascular phenotype.

Reference: Marie I et al. Gastrointestinal mucosal abnormalities using videocapsule endoscopy in systemic sclerosis. 2014. https://pubmed.ncbi.nlm.nih.gov/24889779/