RELATED CONDITIONS: GASTROINTESTINAL
Scleroderma can cause dysmotility (abnormally slow movement of food) in the digestive process.
Overproduction of collagen is typical of scleroderma. This can cause thickening and fibrosis (scarring) of the tissues of the digestive system and gastrointestinal tract, weakening the muscles.
Weakened muscles of the gastrointestinal tract may result in acid reflux.
The esophagus connects the mouth and throat to the stomach. The lower esophageal sphincter acts as a gate, opening to allow food to enter the stomach and closing to prevent food from coming back up. The “gate” of systemic scleroderma patients does not close properly, resulting in a backwash of acid. As the food and acid return into the esophagus, the patient feels a burning sensation called heartburn. The acid may cause scarring and a narrowing (stricture) of the esophagus by injuring the lining of the lower portion of the esophagus.
Acid production can be reduced by avoiding greasy or fatty foods, chocolate, alcohol, spicy foods, tobacco, and caffeine.
Being overweight and wearing girdles or other tight-fitting clothing can also aggravate this problem. Antacids, especially those in liquid form, can also help neutralize acids. These methods can be used to treat problems of acid reflux and heartburn. However, some antacids can cause constipation or diarrhea. Before choosing over-the-counter products, consult your physician or pharmacist. Your physician may also prescribe antacid medications (ex. proton pump inhibitors or H-2 blockers) to decrease stomach acid production or drugs (ex. metoclopramide) to promote muscular activity and improve esophagus function.
Gravity helps keep food and acid in the stomach.
Thus, staying in an upright position after eating is helpful. Other common-sense measures to prevent acid reflux include eating smaller and more frequent meals, avoiding eating for several hours before bedtime, and elevating the head of the bed with wooden blocks (6-8 inches).
Dysmotility and narrowing of the esophagus may cause patients to have difficulty swallowing.
It is important to eat slowly and chew thoroughly. Eating softer foods (ex. preparing food in a blender) and avoiding foods that tend to stick in the throat may make swallowing and digesting easier. The physician may periodically dilate the esophagus if it has narrowed significantly.
If damage to muscles of the small intestine occurs, the weakened muscles will not effectively push food through.
One possible consequence is the overgrowth of bacteria, leading to diarrhea. If the intestine is stretched, patients may experience a bloated, distended feeling and pain. Malabsorption, in which nutrients remain in the intestine rather than being absorbed into the body, may lead to stool abnormalities and weight loss. The physician may suggest reducing the amount of fatty foods in the diet and increasing carbohydrate intake, or he/she may prescribe antibiotics, supplementary fat-soluble vitamins, and/or iron.
If muscles of the colon wall become weak or scarred, bowel function may be reduced.
This results in constipation or other colon abnormalities. High fiber intake and at least six to eight glasses of fluids daily, especially water, will help prevent constipation. Fresh fruits and vegetables act as natural laxatives, and exercise can help maintain regular bowel movements. The physician may also recommend stool softeners or bulking agents such as Metamucil.