| 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. |
| 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. |
| 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 |
| 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) |
| 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) |
| 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. |
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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. |
| 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. |
| 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 |
| 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. |
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| 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) |
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| 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. |
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| Esophagus (Throat) |
| Esophageal (Throat) Involvement. Scleroderma can cause Barrett's Esophagus, esophageal diseases, esophageal stricture, and esophageal ulcers. ISN. |
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| 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. |
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| 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. |
| 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. |
| 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. |
| 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 |
| 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. |
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| 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) |
| 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. |
