| Gastrointestinal Involvement (Main Menu) |
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| Overview of Gastrointestinal Involvement |
| These symptoms may occur in systemic scleroderma but not in localized scleroderma, such as Linear and Morphea. See Types of Scleroderma. This page was written by Shelley Ensz, and has not yet been medically edited. Scleroderma (SD) affects everyone differently. Just because something is listed here does not mean an individual patient will ever experience it, nor does it mean it is caused by scleroderma. See Disclaimer. |
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| What is GI Involvement in Scleroderma? |
| GI involvement consists of a variety of symptoms and conditions that include nausea and vomiting, difficulty with swallowing, constipation, diarrhea, GERD (gastroesophageal reflux disease), problems with digestion, gastroparesis, and watermelon stomach. |
| Some of these symptoms are bothersome and can have a serious affect on your quality of life. Others are life threatening. All should be taken seriously and discussed with your doctor. |
| Gastrointestinal manifestations of systemic sclerosis. Systemic sclerosis is a chronic disorder of connective tissue that affects the gastrointestinal tract in more than 80% of patients. Domsic R. (PubMed) Dig Dis Sci. 2008 May;53(5):1163-74. |
| Gastrointestinal symptoms and motility disorders in patients with systemic scleroderma. In scleroderma patients dyspepsia (mainly gastric fullness), restricted distension of the gastric antrum and diffuse gastrointestinal dysmotility are frequent features. (PubMed) BMC Gastroenterol. 2008 Feb 27;8(1):7. |
| Home parenteral nutrition (HPN): an effective and safe long-term therapy for systemic sclerosis-related intestinal failure. HPN can be safely and successfully used long-term in patients with SSc and should be considered for patients unable to maintain their nutritional status because of severe gastrointestinal involvement. (PubMed) Rheumatology (Oxford). 2008 Feb;47(2):176-9. |
| Severe Fibrosis and Increased Expression of Fibrogenic Cytokines in the Gastric Wall of Systemic Sclerosis Patients. This study provides the first evidence that a severe fibrosis with a pronounced deposition of different collagen types, myofibroblast differentiation and an increased expression of several profibrotic factors are important hallmarks in the gastric wall of SSc patients. Mirko Manetti. 1217/449. ACR 2007. |
| Correlation with other Symptoms |
| Severe fibrosis and increased expression of fibrogenic cytokines in the gastric wall of systemic sclerosis patients. A pronounced deposition of collagen, the presence of myofibroblasts, and increased expression of several profibrotic factors are important hallmarks in the stomach of patients with SSc. Wiley InterScience. Arthritis and Rheumatism. Volume 56, Issue 10 , Pages 3442 - 3447. (Also see: Causes of Scleroderma: Cytokines) |
| Characteristics of Patients with Early Systemic Sclerosis and Severe Gastrointestinal Tract Involvement. Our findings strongly suggest the existence of a subgroup of SSc patients with severe GIT involvement in the early stage. Among the Japanese individuals, these patients never developed severe ILD, even though they were classified as having diffuse cutaneous SSc. J Rheumatol 2007;34:2050-5. (Also see: Pulmonary Fibrosis) |
| Gastrointestinal Symptoms, Perceived Functioning and Quality of Life Issues Correlate with Gastric Myoelectrical Activity in Systemic Sclerosis (SSc) Patients. GI symptoms, quality of life issues and perceived functioning significantly correlated with gastric myoelectrical activity, which has been shown to reflect gastric dysmotility in SSc patients. Terry A. McNearney. 1137/396 ACR 2006. (Also see: Scleroderma Quality of Life) |
| Gastrointestinal Symptoms are Associated with Worse Sf36 Scores in Systemic Sclerosis (SSc). Patients with SSc report poor HRQoL, both on a physical and psychological level. GI symptoms are common in SSc and are associated with significantly poorer mental health. Assessing and treating GI manifestations in SSc could help improve the quality of life and psychological wellbeing of patients suffering from SSc. Suzanne Taillefer. 1570/346. ACR 2005. |
| Digestive Involvement |
 Digestive involvement in systemic sclerosis is frequent and serious, because it provides morbidity and fatality. The symptomatic treatments must be systematic and improve the disease's overall prognosis. PubMed. Rev Prat. 2002 Nov 1;52(17):1896-900.
Assessment of gastrointestinal involvement. A minimal core set of variables has been identified to be used in clinical investigation for the assessment of esophagus, stomach, small intestine, colon and anorectum involvement in scleroderma patients. PubMed. Clin Exp Rheumatol. 2003;21(3 Suppl 29):S15-8. |
| Markers Of Fibrosis In The Upper Gastrointestinal Tract Of Patients With Systemic Sclerosis. Our results show that different markers for fibrosis can be demonstrated in SSc stomach. Moreover, the involvement of gastric wall components in fibrosis most likely is involved in the decreased mobility and atrophy of the stomach in SSc patients. M. Manetti THU0296 EULAR 2007. |
| Gastrointestinal Involvement in Patients with Systemic Sclerosis. Gastrointestinal involvement in patients with systemic sclerosis is quite frequent and implies sustained monitoring and periodic evaluation in order to prevent complications. P. Ciurea. AB0269 EULAR 2006. |
| Pneumatosis cystoides intestinalis (PCI) with systemic sclerosis, limited type resulting in a poor prognosis. PCI is rarely complicated with SSc, and all cases previously reported were associated with diffuse SSc. PubMed. Am J Med Sci. 2006 Aug;332(2):100-2. (Also see: Limited Scleroderma) |
| Autonomic nerve function in patients with systemic scleroderma using heart rate variability analysis. The results suggest that in SSc patients, sympathetic nerve activity was increased and parasympathetic nerve activity was decreased throughout the day. PubMed. Rinsho Byori. 2006 Apr;54(4):325-8. (Also see: Cardiac Involvement) |
| Severe gastrointestinal involvement (GIT) in systemic sclerosis. GIT involvement is mainly attributed to GIT dismobility and wide mouth diverticular. GIT involvement in SSc can be also severely debilitating and even life threatening. To our knowledge, the presence of gastrointestinal bleeding due to the presence of multiple peptic ulcers in scleroderma patients is not well described. PubMed. Clin Rheumatol. 2006 Mar 21. |
| Light stimulation relieves oesophagus endoscopy discomfort. Researchers have identified a way of making oesophagogastroduodenoscopy (EGD), a procedure used to examine the lining of the esophagus, stomach, and upper duodenum, less painful. The patient wears special goggles connected to a light signal generator, which delivers stimulation to the patients' closed eyes during EGD and a few minutes after the procedure. Patient Health International 02-27-06. |
| Gastrointestinal Manifestations and Health Related Quality of Life in Systemic Sclerosis (SSc). Patients with SSc report poor health-related quality of life, both on a physical and psychological level. GI symptoms are common in SSc and are associated with significantly poorer mental health. S. S. Taillefer. FRI0125 EULAR 2005. (Also see: Emotional Adjustment) |
| Gastrointestinal Manifestations in Systemic Sclerosis. GI manifestations are relatively common, although non-lethal complications of SSc. Therefore early assessment of GI involvement is necessary to improve quality of life. S. Szamosi. FRI0072 EULAR 2005. |
| Proposal of a questionnaire for prevalence's characterization of the digestive symptoms in the connective tissue diseases. The connective tissue diseases are common causes of many gastrointestinal complaints. The use of an interview plus a predefined questionnaire seems a very effective way to identify and characterize symptoms and is even sometimes able to uncover features unknown before. PubMed. Arq Gastroenterol. 2004 Jan-Mar;41(1):64-70. Epub 2004 Oct 15. |
| Severe gastrointestinal involvement in systemic sclerosis: Report of five cases and review of the literature. GIT involvement in SSc can be severely debilitating and even life-threatening. Although morbidity is inevitable, appropriate supportive treatment can prolong survival. PubMed. Semin Arthritis Rheum. 2005 Feb;34(4):689-702. |
| Asymptomatic Damage of Gastric Mucosa in Systemic Sclerosis. Gastrointestinal involvement is extremely frequent in both diffuse and localized systemic sclerosis (SS). All gastrointestinal segments can be affected, and symptoms are frequently absent until late stages. In this population, noninvasive tests of gastrointestinal function showed multiple abnormalities. On the whole, alterations in gastrointestinal function were more pronounced in diffuse SS patients. G. Randisi. FRI0119 EULAR 2003. |
| Evaluation and Management of Gastro-intestinal Involvement in SSc. Involvement of the GI tract in SSc is second in frequency only to the skin. Although the manifestations of involvements in the different gastrointestinal organ systems may vary considerably, the underlying pathophysiology for involvement of the gastrointestinal tract is the same: The primary abnormality involves dysmotility of the smooth muscle of the entire gastrointestinal tract. P. Clements. SP0011 EULAR 2003. |
| Gastrointestinal manifestations. Collagen vascular diseases are known to present with a diverse array of gastrointestinal manifestations. These can be classified as: 1) gastrointestinal damage due to the collagen vascular disease itself; 2) adverse events caused by pharmacotherapies; or 3) gastrointestinal infections following immunosuppression due to corticosteroid (CS) administration. PubMed. Nihon Rinsho Meneki Gakkai Kaishi. 2004 Jun;27(3):145-55. (Also see: Lupus) |
| Bowel Involvement |
Scleroderma can cause constipation, diarrhea, malabsorption, diminished peristalsis, intestinal pseudo-obstruction, and bowel incontinence.
Many scleroderma patients have irritable bowel syndrome (IBS).
Typical in the initial stages of scleroderma is chronic constipation, sometimes alternating with diarrhea. Late stage scleroderma bowel involvement is often marked by diarrhea, malabsorption, and bowel incontinence. See Bowel Dysfunction by ISN. |
| Dysmotility Syndrome |
| Dysmotility syndrome is a vague, descriptive term used to describe diseases of the muscles of the gastrointestinal tract (esophagus, stomach, small and large intestines) in which the muscles do not work normally (hence the term dysmotility). Other terms that are sometimes used for dysmotility problems are gastroparesis when the stomach is involved, and chronic intestinal pseudo-obstruction when the intestines and stomach are involved. MedicineNet. |
| What are Dysmotilities? Symptoms, diagnosis, treatments, and support. Gastroparesis and Dysmotilities Association. |
| Transcutaneous Electrical Nerve Stimulation (TENS) Improves Upper GI Symptoms and Balances the Sympathovagal Activity in Scleroderma Patients. TENS at GI acupoints offers a potential option in the treatment of upper GI symptoms, but further study is necessary. PubMed. Dig Dis Sci. 2007 Mar 20. |
| A new method for evaluation of intestinal muscle contraction properties: studies in normal subjects and in patients with systemic sclerosis. Systemic sclerosis patients had increased stiffness and impaired muscle dynamics of the duodenum. Decreased muscle function and increased wall stiffness may explain the GI symptoms reported in this patient group. PubMed. Neurogastroenterol Motil. 2007 Jan;19(1):11-9. (Also see: Bowel Dysfunction) |
| Use of endoluminal ultrasound to evaluate gastrointestinal motility. The use of high-frequency ultrasound transducers in the gastrointestinal tract (GI) have made completely invisible portions of the GI tract accessible to investigation. PubMed. Dig Dis. 2006;24(3-4):319-41. |
| Systematic review: pathophysiology and management of gastrointestinal dysmotility in systemic sclerosis. Lifestyle and medical therapy approaches are preferred as they often improve and/or ameliorate symptoms. Surgery is only recommended with serious, rare complications. Alternative therapies such as acupuncture-based therapies are well tolerated, with clinical improvement and may be of potential therapeutic benefit for systemic sclerosis gastrointestinal dysmotility. PubMed. Aliment Pharmacol Ther. 2006 Mar 15;23(6):691-712. |
| Is normal gastric emptying a predictor of normal gastric function? The amplitude of gastric contractions may represent a more sensitive parameter for the detection of gastric dysfunction than does gastric emptying. PubMed. Nuklearmedizin. 2005;44(3):81-85. |
| Prokinetic therapy: What can be measured by gastric scintigraphy? Prokinetic therapy with cisapride stimulates gastric motility, and could be non-invasively monitored by scintigraphy. PubMed. Nucl Med Commun. 2005 Jun;26(6):527-533. |
| Human enteric neuropathies: morphology and molecular pathology. The aim of this study is to review current understanding of the molecular and morphological pathology of the enteric neuropathies affecting motor function of the human gastrointestinal tract. PubMed. Neurogastroenterol Motil. 2004 Oct;16(5):515-31. (Also see: Causes of Scleroderma: Molecular Defect) |
| Thyroid-intestinal motility interactions summary. Thyroid diseases may be related to gastrointestinal motility symptoms. Such symptoms can vary in degree and, sometimes, are the only clue of a thyroid disease or, at least, the first. PubMed. Minerva Gastroenterol Dietol. 2004 Dec;50(4):305-15. (Also see: Thyroid Disease) |
| Domperidone Warning |
| FDA Alert: Detention without Physical Examination of Domperidone, brands names Motilium, Euciton, Cilroton, Praxis, Seronex, Emiken. Domperidone is not approved for any use in the U.S. There have been several published reports and case studies of cardiac arrhythmias, cardiac arrest and sudden death in patients receiving an intravenous form of domperidone. U.S. Food and Drug Administration (FDA). 2004. |
| Domperidone Should Not Be Considered a No-Risk Alternative to Cisapride in the Treatment of Gastrointestinal Motility Disorders. Several cases of QT prolongation and ventricular tachyarrhythmia have been reported with domperidone, a gastrokinetic and antiemetic agent available worldwide but still under investigation in the United States. American Heart Association. Circulation 2000:102:1883. |
| Dysphagia (Difficulty Swallowing) |
| Scleroderma can cause dysphagia, which is difficulty in swallowing. This can range from minor, occasional problems to such severity that a patient has to be fed through tubes or intravenously. See: Dysphagia by ISN. |
| Esophagus (Throat) |
| Scleroderma can cause Barrett's Esophagus, Esophageal Diseases, Esophageal Stricture, and Esophageal Ulcers. See: Esophagus by ISN. |
| Modified Roux-en-Y Aids Esophageal Scleroderma. Roux-en-Y gastric bypass (RYGBP) provides better control of medically refractory gastroesophageal reflux and dysphagia with far less abdominal bloating than does fundoplication, the most widely used operation in the treatment of esophageal scleroderma. Skin & Allergy News. Volume 38, Issue 3, Page 72 (March 2007) |
| Esophagus: Reflux (Heartburn) |
| There are many effective treatments and lifestyle modifications for Reflux (Heartburn) which is very common in Scleroderma patients. |
| Body-Mass Index and Symptoms of Gastroesophageal Reflux in Women. Body-mass index (BMI) is associated with symptoms of gastroesophageal reflux disease in both normal-weight and overweight women. Even moderate weight gain among persons of normal weight may cause or exacerbate symptoms of reflux. The New England Journal of Medicine. Vol 354:2340-2348. 06/01/06. |
| The pattern of esophageal manometry in progressive systemic sclerosis. Patients with progressive systemic sclerosis usually present with heartburn, dysphagia and regurgitation. Esophageal manometry typically shows lower pressure and aperistalsis. Gastroesophageal reflux is frequent. PubMed. Saudi Med J 2003 Jan;24(1):68-71. |
| See: Reflux (Heartburn) by ISN. |
| Gastroparesis |
| What is Gastroparesis? Symptoms, diagnosis, treatments, and support. Gastroparesis and Dysmotilities Association. |
| Gastroparesis: clinical update. Gastroparesis refers to chronically abnormal gastric motility characterized by symptoms suggestive of mechanical obstruction and delayed gastric emptying in the absence of mechanical obstruction. It may be idiopathic or attributable to neuropathic or myopathic abnormalities, such as diabetes mellitus, postvagotomy, postviral infection, and scleroderma. PubMed. Am J Gastroenterol. 2006 May;101(5):1129-39. |
| Oral erythromycin and symptomatic relief of gastroparesis. a systematic review. Erythromycin is a motilin agonist that greatly increases the fractional rate of gastric emptying. The aim of this study was to review clinical trials of erythromycin to determine the efficacy of this agent in producing symptom relief in patients with gastroparesis. Thirty-five clinical trials were identified, and five met inclusion criteria. One study each involved gastroparesis caused by surgery and systemic sclerosis. Well-designed trials designed to assess symptom relief in gastroparesis are needed. PubMed. Am J Gastroenterol 2003 Feb;98(2):259-63. |
| Delayed gastric emptying in patients with diffuse versus limited systemic sclerosis, unrelated to gastrointestinal symptoms and myoelectric gastric activity. The higher prevalence of delayed gastric emptying in patients with dSSc in this study indicates a more severe involvement of the gastrointestinal tract in dSSc than in lSSc, and stresses the importance of differentiating between the subtypes of SSc patients. PubMed. Scand J Rheumatol. 2003;32(6):348-55. (Also see: Diffuse Scleroderma) |
| Gastroparesis Personal Stories |
| Jason: Linear Scleroderma I have recently been diagnosed with Raynaud's as well, have had gastrointestinal difficulties more common to systemic forms, and have witnessed these lesions grow and deepen rather than decrease in size... |
| Jody: Fibromyalgia/Difficult Diagnosis In Sudan, I was on IV for heat stroke and food poisoning. And in Thailand, at the end of March, it all came to a crashing halt... |
| Sandy J: CREST Scleroderma I have had an ileostomy for two years and a feeding peg for just over one year, and would appreciate comments from any person who also has one or both of these problems... |
| Tami: Morphea Scleroderma I have gotten used to the stares everyone casts my way because in their eyes I am different. Unique, I guess... |
| Trish: Spouse of a Diffuse Scleroderma Patient My husband was diagnosed with scleroderma in June of 2000... |
| Loss of Appetite |
| Loss of Appetite. A loss of appetite can be quite concerning when it fails to go away. It can be a sign of a serious underlying condition, such as depression or cancer. It also commonly occurs during a sudden illness, such as an infection. When a loss of appetite continues for a long time, a person is at risk for malnutrition. Scleroderma is just one of many possible causes of loss of appetite. University of Illinois Medical Center. |
| What are the treatments for loss of appetite? There are medications available to try to stimulate appetite in people with an incurable cause for their loss of appetite. These medications include megestrol (i.e., Megace) and dronabinol (i.e., Marinol). If nausea is the main reason for the loss of appetite, medications to treat nausea, such as promethazine (i.e., Phenergan), prochlorperazine (i.e., Compazine) or ondansetron (i.e., Zofran), can be given. University of Illinois Medical Center. |
| Watermelon Stomach |
| Gastric Antral Vascular Ectasia is popularly known as "Watermelon Stomach." These are parallel red sores inside the lining of the stomach which look like the stripes on a watermelon. See: Watermelon Stomach by ISN. |
| Additional Research |
| Intestinal immune activation in juvenile idiopathic arthritis and connective tissue disease. The majority of children suffering from JIA or CTD with GI symptoms show abnormalities consistent with activation of the intestinal immune system. The aetiology of this reaction remains unknown, but similar features are seen in delayed-type food allergy. Scandinavian Journal of Rheumatology, Volume 36, Issue 5 2007 , pages 386 - 389. (Also see: Arthritis and Connective Tissue Disease). |
| Stomach home to array of bacteria: study finds. What few people know is that the human stomach is home to a vast ecosystem of microbial life that appears to have adapted to one of the harshest biological environments imaginable. Researchers at Stanford University in California identified DNA from 128 different species of bacteria - including one whose closest relative is found in, of all places, radioactive waste dumps. CTV.ca Updated 01/11/06. |
| Correlates of Depression, Including Overall and Gastrointestinal Functional Status, Among Patients with Systemic Sclerosis. Decreased functional status and abnormal GI functioning are significantly correlated with depression among patients with SSc. Other demographic and clinical indicators are also associated with depression. J Rheumatol. NO. 1 January 2005;32:51-7. (Also see: Emotional Adjustment) |
| Cytokines as therapeutic targets for the gastrointestinal manifestations of scleroderma. In the present review, the involvement of cytokines in systemic sclerosis (SSc) is discussed with particular emphasis on cytokines and growth factors that have been implicated in the disease process and likely play an important role in the gastrointestinal manifestations of scleroderma. PubMed. Can J Gastroenterol. 2004 Jan;18(1):22-4. |
| Interstitial lung disease (ILD) in Systemic Sclerosis (SSc) and its Association with Esophageal Motility Disturbance. Our single center study suggests a positive correlation of digital infarct with ILD in diffuse SSc and a positive correlation of esophageal motility disturbance and ILD; but there was no effect on severity of ILD in SSc patients and no difference in severity of ILD in diffuse and limited cutaneous SSc. R. Gupta. AB0333 EULAR 2003. (Also see: Pulmonary Involvement) |
| A case of scleroderma with pancytopenia due to lack of trace elements. As patients with scleroderma sometimes develop gastrointestinal problems and are needed intravenous nutrition of long duration, they should be paid attention to lack of trace elements that can be a cause of hematologic complications. PubMed. Ryumachi 2002 Dec;42(6):903-9. (Also see: Associated Conditions: Pancytopenia) |
| Chest Pain, Chronic Many different types of problems can cause discomfort, shortness of breath, pain with swallowing, and many other symptoms in the chest area. This chart may help you pinpoint your problem as you confirm your symptoms. familydoctor.org, |
| Elimination Problems Use this chart when you or a family member has pain, itching or blood with a bowel movement. familydoctor.org. |
| High incidence of Helicobacter pylori infection in patients with systemic sclerosis: association with Sicca Syndrome. In patients with Systemic Sclerosis we found an enhanced frequency of HP infection. PubMed. Int J Immunopathol Pharmacol 2001 May-Aug;14(2):81-85. |
| Nausea and Vomiting Many illnesses can cause stomach pain, nausea and vomiting. Some are mild sicknesses that will pass by themselves, but others are serious and need medical attention. familydoctor.org. |
