Digestive system and gastrointestinal tract
People with systemic scleroderma may develop abnormalities of the digestive system and gastrointestinal tract from the mouth to the anal canal. The overproduction of collagen typical of scleroderma can cause thickening and fibrosis (or scarring) of the tissues. This can result in weakened muscles, and lead to the abnormally slow movement of food (dysmotility) in the digestive process.
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Esophageal
dysfunction
Food
travels from the mouth and throat into the stomach through a tube called the
esophagus. Normally, the lower esophageal sphincter, or valve, acts as a gate
which opens to allow food to enter the stomach and then closes promptly to
prevent food from coming back up. In systemic scleroderma, the gate does not
close properly and the result is a backwash of acid and a burning sensation
(heartburn) as food and acid return into the esophagus. The acid may also
injure the lining of the lower portion of the esophagus, causing scarring and a
narrowing (stricture) of the tube.
Acid production can be reduced, and the problems of acid reflux and heartburn helped, by avoiding alcohol, greasy or fatty foods, spicy foods, chocolate, tobacco and caffeine. Antacids (particularly in liquid form) can help neutralize acids and reduce heartburn. Some antacids cause constipation while others cause diarrhea. Consult your physician or pharmacist when choosing over-the-counter products. Your doctor may prescribe antacid medications such as proton pump inhibitors or H-2 blockers to decrease acid production in the stomach. The physician also may prescribe a drug such as metoclopramide which promotes muscular activity and causes the esophagus to work better.
The force of gravity helps to keep food and acid in the stomach; therefore, an upright position after meals is helpful. Other common-sense measures to prevent acid from coming up into the esophagus include eating smaller and more frequent meals, not eating for several hours before bedtime, and elevating the head of the bed six-to-eight inches with wooden blocks. Being overweight is harmful, and you should avoid wearing girdles or other tight-fitting garments.
Swallowing
difficulties
Abnormally
slow movement of food and narrowing of the esophagus may cause swallowing
difficulties. Eating slowly and chewing thoroughly are important. Swallowing
and digesting are made easier by eating softer foods (many foods can be
prepared in a blender) and avoiding foods which tend to stick in the throat. If
the esophagus has narrowed significantly, the physician may need to dilate the
esophagus periodically to permit easier swallowing.
Diarrhea
In
systemic scleroderma, there can be damage to the muscles of the small bowel
(small intestine). The weakened muscles do not work effectively to push food
through the bowel. Simply put, things sit rather than move well. One
consequence can be an overgrowth of bacteria, leading to diarrhea. There also
may be a bloated, distended feeling and some pain if the bowel is stretched.
Another effect is that the nutrients of food remain in the bowel instead of
being absorbed into the body. This condition is called malabsorption, and it
may lead to weight loss and stool abnormalities.
For diarrhea or malabsorption, the physician may prescribe an antibiotic, or supplementary fat-soluble vitamins, and/or iron. Your doctor also may suggest that you reduce the amount of fatty foods in your diet and increase your carbohydrate intake.
Constipation
Weak
or scarred muscles in the colon wall make it difficult for the bowel to work
well, resulting in constipation or other abnormalities of the colon.
Maintaining a diet high in fiber, and drinking at least six-to-eight glasses of
fluids daily, especially water, will help prevent constipation. Fresh fruits
and vegetables are natural laxatives. Exercise also helps to keep bowel
movements regular. Your doctor also may recommend stool softeners and bulking
agents like Metamucil®.