Gastrointestinal Complications and Their Treatments

Mild to severe GI problems are common in most people who are living with scleroderma.

The gastrointestinal (GI) tract includes all the parts of the body that are involved in consuming and processing the food we eat and eliminating waste—the mouth, esophagus, stomach, liver, intestines, colon, and anus. More than 90% of those living with scleroderma experience some form of GI problems. This can appear in many forms and involve different levels of risk, from simple indigestion to esophageal blockage.

Most GI symptoms can be managed with help from the healthcare team.

For the majority of patients, GI problems are common, inconvenient, and sometimes embarrassing. Experiencing symptoms over time can contribute to depression and affect a person’s quality of life. Severe GI complications affect only about 10% of people with scleroderma, but the effects can be serious. Fortunately, most GI symptoms can be managed with help from the healthcare team.

GI symptoms can include pain, difficulty swallowing, vomiting, diarrhea, bloating, constipation, fecal incontinence, and difficulties with digestion and absorption of nutrients that can cause significant weight loss.

Problems with the esophagus that result in swallowing difficulties and heartburn are the most common risks among people with scleroderma. Other risks can include:

  • Gastroesophageal reflux disease or GERD (also called acid indigestion or heartburn) is the most common problem; it occurs when stomach acids back up into the esophagus and cause irritation. Reflux may also contribute to aspiration (inhaling) of stomach acids, which can contribute to lung irritation and disease
  • Damage to the esophagus caused by abnormal cell growth; this can cause swallowing difficulties and affect how well the esophagus moves food to the stomach, and in severe cases may cause blockage or increase the risk of esophageal cancer
  • Nausea, vomiting, diarrhea, constipation, bloating
  • Damage to the intestines, which hinders the absorption of nutrients and may cause substantial weight loss and malnutrition

Because of the complexity of the GI system, diagnostic techniques differ according to the location of the symptom or problem.

Treatments

Treatments for the various GI complications of scleroderma usually focus on symptom management.

Because many people with scleroderma are at risk for malnutrition due to intestinal dysfunction, regular assessment of each patient’s nutritional status should be part of the treatment plan.