| Gastrointestinal Involvement (Main Menu) |
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| Bowel Dysfunction in Systemic Scleroderma |
| These symptoms may occur by themselves or along with other diseases or 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 that it is due to scleroderma or that an individual patient will ever experience it. See Disclaimer. |
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| Bowel Dysfunction in Scleroderma |
| Scleroderma can cause constipation, diarrhea, malabsorption, diminished peristalsis, 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. |
| Normal Bowel Function Restored After Oxygen Therapy in Systemic Sclerosis and Colonic Inertia. Colorectal involvement with obstructed defecation is a common complication of progressive systemic sclerosis (pSSc), compromising quality of life and placing patients at risk for life-threatening complications. J Rheumatol 2007; 34:1777-8. |
| Outcome of small-bowel motor impairment in systemic sclerosis--a prospective manometric 5-yr follow-up. Our study highlights the usefulness of small-bowel manometry in symptomatic SSc patients in objectively defining both the characteristics and degree of motor impairment. PubMed. Rheumatology (Oxford). 2006 Jun 16. |
| Causes of Bowel Dysfunction in Systemic Scleroderma |
| Peristalsis: Scleroderma can cause diminished peristalsis. Peristalsis is the wavelike motion in the muscles of the GI tract. |
| Abdominal distention is a common condition, which usually results from over-eating, rather than from a serious illness. It can also be caused by lactose intolerance, air swallowing, irritable bowel syndrome, and partial bowel obstruction. Medline Plus. |
| Antibiotics May Not Cause Diarrheal Bacteria. This study found that the highest risk of C. difficile infection from antibiotic use happens in the 30 days following treatment. "Beyond the 45-day period following treatment, the risk declines significantly. Womenshealth.gov. 10/10/08. |
| Researchers study the possible relationship between myopathies and celiac disease. The scientists are considering the possibility that, at least in part, some inflammatory myopathies are a clinical expression of intolerance to gluten, though they point out the need for more studies to be carried out to confirm or support these findings. innovations report. 02/23/07. (Also see: Celiac Disease and Dermatomyositis and Polymyositis) |
| Gluten Intolerance Quadruples Susceptibility To Tuberculosis. It affects up to 1% of the population, and has been linked to several autoimmune diseases, as well as an increased likelihood of lymph gland cancer and complications of pregnancy. Medical News Today. 10/17/06.(Also see: Celiac Disease) |
| Inflammatory Bowel Disease (IBD) Linked to Risk of Multiple Sclerosis (MS). People with inflammatory bowel disease have a higher than normal risk for developing multiple sclerosis and other autoimmune disorders, such as asthma, arthritis, chronic kidney disease, psoriasis, bronchitis. WebMD. 09/01/05. (Also see: Multiple Sclerosis) |
| 'Sweet' diagnostics kit developed to help bowel disease sufferers. The Israeli company Glycominds has developed a diagnostic blood test kit which quickly enables differential diagnosis between Crohn's disease, ulcerative colitis and irritable bowel syndrome. Israel21c. 05/29/05. |
| Diagnosis, Pathophysiology, and Treatment of Irritable Bowel Syndrome Irritable bowel syndrome (IBS), in its essence, can be defined as a combination of abdominal pain or discomfort and altered bowel habit. Kevin W. Olden, MD October 29, 2003 12/04/03. |
| Impaired rectoanal inhibitory response in scleroderma (systemic sclerosis): an association with fecal incontinence. Impaired RAIR was closely correlated with fecal incontinence, suggesting a possible neural mechanism for maintenance of continence. PubMed. Dig Dis Sci. 2004 Jun;49(6):1040-5. |
| Superior mesenteric artery blood flow in systemic sclerosis patients. Intestinal involvement is frequently observed in systemic sclerosis (SSc) and is associated with malnutrition and a decreased survival rate. Vascular lesions are claimed to underlie and precede these changes. This study showed that even In the absence of symptoms of small bowel involvement, reversible SMA vasoconstriction is demonstrable in the fasting state in SSc patients. Rheumatology (Oxford) 2002 Jul;41(7):730-4 |
| Assessment of intestinal permeability and orocecal transit time in patients with systemic sclerosis: analysis of relationships with epidemiologic and clinical parameters. Correlations between increased IP and duration of disease and degree of gastrointestinal involvement appear to support the hypothesis of secondary involvement of the intestinal barrier, and the presence of anti-Scl70 antibodies in 82% of the patients with higher IP clearly reinforces the hypothesis of an altered immune response in these subjects. PubMed. Rheumatol Int. 2003 Sep;23(5):226-30. |
| Constipation: Treatments (1) |
| Type of Product | Generic Name | Brand Names | | Bulking Agents | polycarbophil | FiberCon ® or Fiberall ® | | | psyllium | Metamucil ® | | Softening Agents | docusate | Colace ® | | Others | lactulose
bisacodyl | Cephulac ®, Cholac ®
Dulcolax ® | |
| Medication shows promise for patients with severe chronic constipation. Patients who met the study criteria were randomly assigned to receive either of two dosage levels of prucalopride, a medication that stimulates protein receptors involved in contraction of the colon, or a placebo. EurekAlert! 05/28/08. |
| Diarrhea: Treatments (Small Bowel Dysfunction) (1) |
| Type of Product | Generic Name | Brand Names | | Broad Spectrum Antibiotics | tetracycline, ampicillan, vancomycin | | | | metronidazole | Flagyl ® | | | clarithromycin | Biaxin ® | | | azithromycin | Zithromax ® | | Investigational for SD | octreotide acetate | Sandostatin ® | |
| Probiotics for Preventing and Treating Nosocomial Infections. Probiotics can prevent episodes of antibiotic-associated diarrhea, but their utility in treating and preventing Clostridium difficile-associated diarrhea requires demonstration of benefit in multicenter clinical trials, preferably sponsored by the National Institutes. Chest. 2007; 132:286-294. (Also see: Alternative Therapies) |
| Bowel Incontinence |
| Medium-term results of permanent sacral nerve stimulation for faecal incontinence. Sacral nerve stimulation is a safe and effective treatment for faecal incontinence when conventional treatment has failed. There is minimal morbidity. The benefit is maintained in the medium term. Br J Surg 2002 Jul;89(7):896-901 PubMed |
| Sacral nerve stimulation for faecal incontinence due to systemic sclerosis. Sacral nerve stimulation is a safe and effective treatment for resistant faecal incontinence secondary to scleroderma. Gut 2002 Dec;51(6):881-3 PubMed |
| Bowel Management |
| Eating 1 to 2 tablespoons a day of live culture acidophilus yogurt may be helpful for combatting bowel involvement with systemic scleroderma, especially small bowel bacterial overgrowth. It may also be particularly helpful when taking antibiotics. It has the additional benefit of being nutritious and easy to swallow. Only a very few brands/types of yogurt (especially in the U.S.) have live cultures, so study product labels carefully. |
| FDA Approves Lialda™ (Mesalamine), the First Oral Once-Daily Mesalamine For Patients With Active, Mild to Moderate Ulcerative Colitis. Clinical studies that found Lialda (2.4 g/day and 4.8 g/day) was effective in inducing remission in patients with active, mild to moderate ulcerative colitis compared to placebo after eight weeks of treatment. Doctor's Guide. 01/17/07. |
| The Majority Of Ulcerative Colitis Patients Are Not Compliant With Medications, CCFA Survey Finds. These findings are significant because an earlier study found that patients less than fully compliant experience five times the number of disease flare-ups. Medical News Today. 12/31/06. |
| Report focuses on the role good microbes play in future medicine. Beneficial microbes, such as probiotics, could represent the future of medicine, with the potential to treat a variety of diseases in humans and animals from diarrhea and eczema to gum disease and autoimmune disorders. EurekAlert! 06/08/06. (Also see: Bowel Dysfunction and Alternative Therapies) |
| New studies examine the evidence on probiotics in Irritable Bowel Syndrome (IBS). A new study of the probiotic strain B. infantis 35624 shows promising results in normalizing frequency of bowel movements in patients suffering from constipation or diarrhea - the two ends of the spectrum in IBS. There was a significant variation in the effect of probiotics across the studies. The Mayo researchers note that larger trials are needed. Medical News Today 11/04/05. (Also see: Alternative Remedies) |
| Acidophilus and Other Probiotics. Lactobacillus acidophilus is a "friendly" strain of bacteria used to make yogurt and cheese. Although we are born without it, acidophilus soon establishes itself in our intestines and helps prevent intestinal infections. Acidophilus is one of several microbes known collectively as probiotics (literally, "pro life," indicating that they are bacteria and yeasts that help rather than harm). Memorial Hospital Jacksonville. March 2005. (Also see: Alternative Therapies) |
| Elimination Problems Use this chart when you or a family member has pain, itching or blood with a bowel movement. familydoctor.org |
| Using Relaxtion: Coping with Functional Gastrointestinal Disorders. Relaxation training is a integral component of behavioral therapies for managing chronic pain, promoting health, and helping patients cope with life-threatening illness such as breast cancer. Relaxation can also assist in managing functional GI disorders. UNC Center for Functional GI & Motility Disorders. |
| International Foundation for Functional Gastrointestinal Disorders People who think they have irritable bowel syndrome can call (888) 964-2001 for more information, weekdays from 9:30 a.m. to 6:00 p.m. Eastern. |
| 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 |
| Bowel Surgery: Ileostomy, Colostomy, and Ileoanal Reservoir |
| Ileostomy, Colostomy, and Ileoanal Reservoir Surgery. Sometimes treatment for Crohn's disease, ulcerative colitis, and familial adenomatous polyposis involves removing all or part of the intestines. NDDIC. |
| 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... |
| Habba Syndrome |
| What is Habba Syndrome? It is an association between a dysfunctional, intact gallbladder and chronic diarrhea. Patients with the syndrome present with varying degrees of chronic diarrhea (three or more bowel movements per day for at least three months). HabbaSyndrome.com |
| New Relief for Chronic Diarrhea. A study in the August 2000 issue of the American Journal of Gastroenterology shows that people with chronic, intractable diarrhea may be suffering from gallbladder dysfunction. Treatment with a drug known as cholestyramine, or Questran, originally developed for patients who have had their gallbladders removed, may bring relief when other approaches have failed. WedMD. August 1, 2000. |
| Intestinal Pseudo-Obstruction |
| Intestinal Pseudo-Obstruction Intestinal pseudo-obstruction (false blockage) is a condition that causes symptoms like those of a bowel obstruction (blockage). Symptoms include cramps, stomach pain, nausea, vomiting, bloating, fewer bowel movements than usual, and loose stools. Diseases that affect muscles and nerves, such as lupus erythematosus, scleroderma, or Parkinson's disease, can cause symptoms. NIDDK |
| 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: Gastrointestinal Involvement) |
| Chronic Intestinal Pseudo-Obstruction. Chronic intestinal pseudo-obstruction (CIP) is a gastrointestinal motility disorder characterized by chronic symptoms and signs of bowel obstruction in the absence of a fixed, lumen-occluding lesion. In patients with symptoms suggestive of bacterial overgrowth, courses of antibiotics such as metronidazole, ciprofloxacin, and doxycycline may be needed. PubMed. Curr Treat Options Gastroenterol. 2005 Feb;8(1):3-11. |
| Small intestinal manometry in patients with systemic sclerosis. In eight out of 10 patients the manometric criteria for intestinal pseudo-obstruction were fulfilled, with a motility pattern consistent with both neuropathy and myopathy. The release of motility-regulating peptides was unaffected. PubMed. Eur J Gastroenterol Hepatol. 2005 Nov;17(11):1205-12. |
| Intestinal Bacterial Overgrowth |
| Altered intestinal permeability (IP) in patients with primary fibromyalgia (FM) and in patients with complex regional pain syndrome (CRPS). Small intestinal bacterial overgrowth is often associated with an increased intestinal permeability (IP) in patients with FM. A. Goebel. Rheumatology Advance Access. June 7, 2008. (Also see: Fibromyalgia) |
| Small Intestinal Bacterial Overgrowth(SIBO) in Patients Suffering From Scleroderma(SSc) : Clinical Effectiveness of Its Eradication. SIBO occurs more frequently in SSc patients than in controls. Orocecal transit time is significantly delayed in SSc patients, suggesting an impairment of intestinal motility, a further risk factor for the development of SIBO. (Blackwell Synergy) Am J Gastroenterol 2008;103:1–6. |
| Penn researchers find relief for gastrointestinal illnesses. Rifaximin is a new drug treatment option for small bowel bacteria overgrowth (SBBO) which prevents the body from absorbing enough nutrients from the small intestines; and pouchitis. EurekAlert! 05/18/05. |
| Small intestinal bacterial overgrowth: a framework for understanding irritable bowel syndrome. The gastrointestinal and immune effects of SIBO (small intestinal bacterial overgrowth) provide a possible unifying framework for understanding frequent observations in IBS, including postprandial bloating and distension, altered motility, visceral hypersensitivity, abnormal brain-gut interaction, autonomic dysfunction, and immune activation. PubMed. JAMA. 2004 Aug 18;292(7):852-8. |
| Inflammatory Bowel Disease (IBD) |
| Inflammatory Bowel Disease (IBD) should not be confused with Irritable Bowel Syndrome (IBS) which is less severe. Two kinds of inflammatory bowel disease are Crohn's disease and ulcerative colitis. |
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| Irritable Bowel Syndrome (IBS) |
| Irritable Bowel Syndrome. Up to one in five American adults has irritable bowel syndrome (IBS). For most people, signs and symptoms of IBS are mild. In many cases, you can control irritable bowel syndrome by managing your diet, lifestyle and stress. MayoClinic. |
| How Effective Are Probiotics In Irritable Bowel Syndrome (IBS)? A systematic review of the efficacy of probiotics in IBS patients found that "probiotics are effective in IBS; however, there was not enough information to be sure whether there is one probiotic that is particularly effective or whether combinations of probiotics are required. ScienceDaily. 10/10/08. (Also see: Probiotics) |
| Brain Response Differences Found In The Way Women With IBS Anticipate And React To Pain. Women with IBS cannot effectively turn-off a pain modulation mechanism in the brain, which causes them to be more sensitive to abdominal pain. Medical News Today. 01/09/08. |
| Tissue Destruction Blocked By Natural Product From Amazon Rainforest. The discovery's unique actions suggest a broad set of applications in various joint, skin and gastrointestinal diseases, including osteoarthritis and irritable bowel syndrome. Medical News Today. 10/25/07. (Also see: Arthritis) |
| IBS Drug Zelnorm Taken Off U.S. Market. FDA: Voluntary Withdrawal Due to Risk of Heart Attack, Stroke, Chest Pain. A popular drug for irritable bowel syndrome and constipation was pulled from the U.S. market Friday amid new evidence that it raises the risk of heart attacks and strokes. WebMD Medical News. March 30, 2007. |
| Study: Antibiotic gives hope to patients with Irritable Bowel Syndrome (IBS). A new study found that patients reported greater global improvements in IBS symptoms and less bloating after taking rifaximin than patients taking placebo. EurekAlert! 10/16/06. |
| Importance of T cells in the prevention of autoimmune diseases. Researchers found that healthy individuals have up to twice the number of disease-fighting regulatory T cells compared with Irritable Bowel Disease patients at the onset of disease. News-Medical.net 07/09/06. (Also see: Causes of Scleroderma: B cells and T cells) |
| Hypnotherapy Improves Quality Of Life For People With Irritable Bowel Syndrome. Patients with Irritable Bowel Syndrome who took part in hypnotherapy sessions reported reduced symptoms and improved quality of life. Medical News Today. 05/31/06. |
| Irritable Bowel Syndrome & Diabetes. Having both diabetes and irritable bowel syndrome (IBS) is frustrating. Here's help controlling both. American Diabetes Association. |
| Is it Irritable Bowel Syndrome (IBS) or something else? One common concern of patients with symptoms of IBS is that they have "something else." IBS is common and people may sometimes have another coexisting disorder that is not responsible for their IBS symptoms. Doctors can help sort this out. EndoNurse. 03/20/06. |
| Symptom overlap and comorbidity of irritable bowel syndrome with other conditions. Symptom overlap and comorbidity between IBS and other gastrointestinal motility disorders are frequent. PubMed. Curr Gastroenterol Rep. 2005 Aug;7(4):264-71. (Also see: Fibromyalgia) |
| Small intestinal bacterial overgrowth: a framework for understanding irritable bowel syndrome. The gastrointestinal and immune effects of SIBO (small intestinal bacterial overgrowth) provide a possible unifying framework for understanding frequent observations in IBS, including postprandial bloating and distension, altered motility, visceral hypersensitivity, abnormal brain-gut interaction, autonomic dysfunction, and immune activation. PubMed. JAMA. 2004 Aug 18;292(7):852-8. |
| Malabsorption |
| Scleroderma can cause malabsorption, which is difficulty in the digestion or absorption of nutrients from food substances. |
| "Malabsorption caused by medical problems may be chronic and last for the remainder of a person's life. Some forms of malabsorption can be treated and corrected over time." University of Chicago |
| Home parenteral nutrition (HPN): an effective and safe long-term therapy for systemic sclerosis-related intestinal failure. Although patient numbers were small, our findings suggest that HPN can be safely and successfully used long-term in patients with SSc. Rheumatology 2008 47(2):176-179. |
| Peristalsis |
| Systemic scleroderma can cause diminished peristalsis. Peristalsis is the wavelike motion in the muscles of the gastrointestinal tract. |
| Research |
| Bone and Intestinal Disease May Have Common Cause. In studies with mice, scientists have found evidence that osteoporosis-like bone disorders and inflammatory intestinal disorders are both caused by the abnormal regulation of a common protein. PakTribune. 12/28/06. (Also see: Causes of Scleroderma: T cells) |
| Adacolumn for selective leukocytapheresis as a non-pharmacological treatment for patients with disorders of the immune system: An adjunct or an alternative to drug therapy? Selective depletion of myeloid cells appears to induce anti-inflammatory effects and represents a non-pharmacological treatment for patients with active IBD. The treatment has a clear drug-sparing role. Changes in blood levels of inflammatory and anti-inflammatory factors are thought to contribute to the efficacy of this procedure. PubMed. J Clin Apheresis. 2005 May 12. |
| Nail abnormalities: clues to systemic disease. The visual appearance of the fingernails and toenails may suggest an underlying systemic disease. Clubbing of the nails often suggests pulmonary disease or inflammatory bowel disease. The finding of Beau's lines may indicate previous severe illness, trauma, or exposure to cold temperatures in patients with Raynaud's disease. PubMed. Am Fam Physician. 2004 Mar 15;69(6):1417-24. (Also see: Raynaud's Diagnosis and Pulmonary Involvement) |
| Subtotal colectomy and cecosigmoid anastomosis for colonic systemic sclerosis: report of a case and review of the literature. If surgery is required for colonic involvement in systemic sclerosis, it should be directed at the segmental distribution of the disease, preserving the colon if possible and considering the possibility of concurrent small-bowel involvement. PubMed. Dis Colon Rectum. 2003 Dec;46(12):1706-11. |
| Media Stories |
| Leeches, maggots and parasitic worms can play healing role. Leeches are back into good repute as an accepted treatment for circulatory difficulties in the microsurgical reattachment of skin or body parts. Maggots, are used to remove or "debride" dead tissue in a process called "maggot debridement therapy". 72 percent of patients with autoimmune inflammatory bowel diseases who downed a Gatorade cocktail containing parasitic-worm eggs found symptoms relieved within three months. The Seattle Times 08/04/04. (Also see: Digital Ulcers and Gangrene) |
