Scleroderma

Description

Alternative Names

Treatment for Gastrointestinal Problems

Treatments for abnormalities in the esophagus and stomach are generally the same as those for gastroesophageal reflux (GERD) or heartburn. Many agents are available without prescription that relieve heartburn and mild symptoms.

Proton-pump or acid-pump inhibitors are probably the best agents for GERD related to scleroderma. They work by inhibiting the so-called gastric acid pump that is required for the stomachs cells to secrete acid. The standard agent has been omeprazole (Prilosec). Newer ones, including lansoprazole (Prevacid), pantoprozole (Protonix), esomeprazole (Nexium), and rabeprazole (Aciphex), are more potent but few comparison studies have been conducted to date.

Side Effects. Side effects are uncommon, but can include an allergic reaction, headache, stomach pain, diarrhea, and flatulence. Of some concern was a report of a very severe and wide spread skin rash induced by omeprazole in a women with scleroderma. It should be noted that this is only one incident, but patients should be cautious about any skin change when taking this agent.

Long-Term Complications. The use of proton-pump inhibitors by people with H. pylori may reduce acid secretion sufficiently to cause a condition called atrophic gastritis (chronic inflammation of the stomach).

Agents for Impaired Stomach Muscle Contractions

Metoclopramide. Metoclopramide (Reglan) is sometimes used for patients who have delayed stomach emptying.

Octreotide. Octreotide (Sandostatin), an analog of a natural hormone that suppresses growth hormone, may prove to be very helpful. Small studies have reported improvement in weight and nutrition with the use of this agent. It may even help other symptoms of scleroderma. In one case report, adding the antibiotic erythromycin in combination with octreotide allowed normal nutrition for at least two years.

Agents for Constipation

Prokinetics. Prokinetics improve the muscle action of the esophagus and enhance stomach emptying. Prucalopride is an investigative pro-kinetic agent that showed significant improvement in symptoms and relief from constipation. Similar agents, such as cisapride (Propulsid), are showing promise. Such agents can have serious side effects.

Treatments for Malabsorption

Antibiotics may be effective for the malabsorption syndrome.

Surgeries

Strictures (abnormally narrowed regions in the esophagus) may need to be opened with endoscopic surgery.