| |
| Gastrointestinal Involvement (Main Menu) |
|
|
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. |
|
|
| 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 complications: the most frequent internal complications of systemic sclerosis (SSc). Manifestations of SSc in the gastrointestinal (GI) tract are common, occurring in 50-90% of patients. Oesophageal dysfunction is the most common GI manifestation, but patients may also experience dysfunction of the stomach, small intestine, colon and rectum, each of which can be responsible for severe and distressing symptoms. A Forbes. (PubMed) Rheumatology (Oxford). 2009 Jun;48 Suppl 3:iii36-9. |
| Gastrointestinal manifestations of systemic sclerosis (scleroderma). Nearly 90 percent of patients with systemic sclerosis (scleroderma) have some degree of gastrointestinal (GI) involvement, with approximately one-half being symptomatic. Severe GI problems, including malabsorption and intestinal pseudoobstruction, are much less common, affecting less than 10 percent of patients during the first nine years of illness. Stephanie A Kaye-Barrett, MD. UpToDate for Patients. April, 2010. |
| Gastrointestinal manifestation of systemic sclerosis (SSc) - thickening of the upper gastrointestinal (GI) wall detected by endoscopic ultrasound (EUS) is a valid sign. The EUS revealed a significant thickening of the walls of the upper GI tract in SSc patients. Predominantly, the submucosa and muscularis are enlarged. These results strengthen the hypothesis that increased matrix deposition is an important aspect in the pathogenesis of GI involvement in SSc. Ina Zuber-Jerger Rheumatology, December 14, 2009. |
| Scleroderma Lung Disease. Pulmonary involvement is second in frequency only to esophageal involvement as a visceral complication of systemic sclerosis (SSc) and has surpassed renal involvement as the most common cause of death. Le Pavec J. Clin Rev Allergy Immunol. 2010 Jan 12. (Also see: Pulmonary Involvement) |
| 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. |
| Early Endoscopy in Systemic Sclerosis (SSc) Patients Without Gastrointestinal (GI) Symptoms: A Retrospective Analyse. The results of this study might indicate that oesophago-gastro-duodenoscopy should be performed early in patients diagnosed with SSc, even if they do not report typical symptoms. Early treatment of GI involvement might improve the prognosis. R. Thonhofer. [SAT0231] EULAR 2009. (Also see: Medical Tests) |
| 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. |
| Correlation with Other Symptoms |
| Prognostic factors for lung function in systemic sclerosis: prospective study of 105 cases. To identify prognostic factors for SSc-ILD and to clarify the possible causative role of manometric esophageal involvement. Only diffuse SSc was predictive of a decrease in pulmonary function in this early-SSc cohort. This does not support preliminary data suggestive of a causative role of oesophageal involvement. M. Gilson. European Respiratory Journal. June 18, 2009. (Also see: Pulmonary Fibrosis) |
| 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) |
| 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. |
| Malnutrition Is Common in Systemic Sclerosis: Results from the Canadian Scleroderma Research Group Database. The risk for malnutrition in SSc is moderate and is associated with shorter disease duration, markers of GI involvement, and disease severity. Patients with SSc should be screened for malnutrition, and potential underlying causes assessed and treated when possible. The Journal of Rheumatology, July 2009. (Also see: Diet and Scleroderma) |
| 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. |
| Bowel Involvement |
| Bowel Involvement. Scleroderma can cause constipation, diarrhea, malabsorption, diminished peristalsis, intestinal pseudo-obstruction, and bowel incontinence. 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. ISN. |
|
|
| Dysmotility Syndrome |
| Dysmotility syndrome refers to muscles in the gastrointestinal tract not working properly. This can include the throat (esophagus), stomach, and bowels. When the stomach is affected, it is often called gastroparesis. When it affects the bowels, it may be called intestinal pseudo-obstruction. ISN. (Also see: Esophagus, Gastroparesis, and Bowel Involvement) |
|
|
| Dysphagia (Difficulty Swallowing) |
| Dysphagia is the medical term for difficulty in swallowing. Symptoms include a sensation of food sticking in the throat, chest pressure or 'burning' after eating, or a feeling of choking. Dysphagia can be due to many different things. Occasionally it is one of the symptoms of systemic scleroderma. ISN. |
|
|
| Esophagus (Throat) |
| Esophageal (Throat) Involvement. Scleroderma can cause Barrett's Esophagus, esophageal diseases, esophageal stricture, and esophageal ulcers. ISN. |
|
|
| Esophagus: Reflux (Heartburn) |
| Esophagus: Reflux (Heartburn) and GERD. There are many effective treatments and lifestyle modifications for reflux (heartburn) which is very common in scleroderma patients. ISN. |
|
|
| Gastroparesis |
| What is Gastroparesis? Symptoms, diagnosis, treatments, and support. Gastroparesis and Dysmotilities Association. |
| Gastric Pacemaker Offers Hope for Those With Stomach Disorders. A pacemaker that electrically stimulates the stomach can help control chronic vomiting in people with severe stomach disorders, says a new study. Findings suggest that gastric pacemakers may be effective in patients with other difficult-to-treat gastrointestinal disorders. MedicineNet. 03/31/10. |
| 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. |
| 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. |
| Malnutrition |
| Is Serum Albumin a Marker of Malnutrition in Chronic Disease? The Scleroderma Paradigm. Serum albumin is not useful as a marker for malnutrition in SSc and should not be assumed to be useful as a marker in other chronic diseases. More attention should be paid to clinical features of malnutrition, including assessment of body mass index and unplanned weight loss, and overall disease severity. M Baron. (PubMed) J Am Coll Nutr. 2010 Apr;29(2):144-151. |
| Nutritional status as marker for disease activity and severity predicting mortality in patients with systemic sclerosis (SSc). In patients with SSc, malnutrition is common and not identified by Body Mass Index (BMI). Bioelectrical impedance analysis (BIA) parameters reflect disease severity and provide best predictors for patient survival. Therefore, an assessment of nutritional status should be performed in patients with SSc. Lijana Krause. Ann Rheum Dis. May 2010. (Also see: Diet and Scleroderma) |
| Malnutrition Is Common in Systemic Sclerosis (SSc): Results from the Canadian Scleroderma Research Group Database. The risk for malnutrition in SSc is moderate and is associated with shorter disease duration, markers of gastrointestinal (GI) involvement, and disease severity. Patients with SSc should be screened for malnutrition, and potential underlying causes assessed and treated when possible. Murray Baron. J Rheumatol. October 15, 2009. |
| Watermelon Stomach |
| Watermelon Stomach is the popular name for Gastric Antral Vascular Ectasia (GAVE) — a condition in which the lining of the stomach bleeds, causing it to look like the characteristic stripes of a watermelon when viewed by endoscopy. ISN. |
|
|
| Additional Research |
| 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) |
| 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. |
Get our free Sclero e-Newsletter!
Player Registration for 5th Annual Scoring for Scleroderma Soccer Tournament in Bridgewater, Massachusetts.