![]() 224 Malabsorption and SIBO are not limited to patients with diffuse disease they can also occur in patients with long-standing limited cutaneous sclerosis. Malabsorption in PSS usually results from SIBO secondary to ineffective motility in the small intestine, but other factors (e.g., decreased mucosal blood flow) can also contribute. 224 Small intestinal biopsy specimens might reveal an increased number of plasma cells within the lamina propria and collagen deposits around and between lobules of Brunner glands in the submucosa of the duodenum. Typical histologic findings include atrophy of the muscle layers with increased deposition of elastin and collagen in the submucosa and serosa and between smooth muscle bundles of the muscularis externa. Early pathologic changes are characterized by vasculopathy, which results in ischemia and progressive organ dysfunction. The GI tract is involved to a variable degree in most patients with PSS. Mark Feldman MD, in Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 2021 PSS
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