Scleroderma

Scleroderma is an autoimmune disease that causes the skin, and sometimes other organs of the body, to become hard and thick. In the diffuse form of scleroderma, the esophagus and gastrointestinal tract are often affected. GERD, or gastroesophageal reflux disease, is a condition in which acid in the stomach flows backward up into the esophagus, causing heartburn and other problems.

People with scleroderma often have GERD. The question, of course, is why.

How Scleroderma Causes GERD Symptoms
With scleroderma, the immune system provokes the body into producing too much collagen, the primary protein found in connective tissue. This additional collagen gets deposited within the skin, making it hard. But it can also get deposited in the organs, including the muscles of the esophagus and intestinal walls.

When the valve that keeps stomach acid from escaping up into the esophagus isn’t working well, reflux happens. That valve is called the lower esophageal sphincter.

There are subtypes of scleroderma. More limited forms affect only skin, while other forms attack muscle, lungs, heart, joints, and kidneys. When the muscles of the gastrointestinal tract are involved, the esophagus may be hit the hardest.

“Patients with scleroderma can have very severe GERD due to involvement of the smooth muscle in the [lower] two-thirds of the esophagus, including the lower esophageal sphincter,” says gastroenterologist Lauren B. Gerson, MD, associate professor of medicine at Stanford University in Palo Alto, Calif.

In people with advanced scleroderma, the lower part of the esophagus, including the area around the lower esophageal sphincter, can become hardened and thickened by scleroderma and is less able to function normally. It can no longer smoothly propel food downward into the stomach, and the lower esophageal sphincter can no longer close tightly enough to keep acid in the stomach, where it belongs.

A gastroenterologist can do tests that will help the patient and doctor find out how well the esophagus is working. While scleroderma patients usually have a rheumatologist taking care of their overall condition, they also have to see many specialists, such as gastroenterologists, to take care of specific aspects of their health.

Treating GERD in Scleroderma Patients
Life with scleroderma can be very difficult, but there are medications that can ease GERD, reduce these unpleasant symptoms, and protect your esophagus from the damage of repeated exposure to stomach acid.

“Patients often require anti-reflux medication in addition to pro-[movement] agents,” says Dr. Gerson. These two types of medications help keep acid securely below the lower esophageal sphincter, and help move food promptly down into the stomach, so that the lower esophageal sphincter doesn’t get stretched open for prolonged periods.

You should also talk to your gastroenterologist about whether changing your diet could help, as some types of food and drink tend to result in more reflux.

You may want to try the following approaches to limit acid reflux into the esophagus:

• Eat small meals more often, rather than two or three large meals that distend the stomach.
• Stay upright for one to two hours after eating. Don’t eat right before going to bed, for example, or late at night. This makes it more likely that acid will stay down in your stomach.
• Raise the head of your bed so that you sleep at an angle. This also puts gravity on your side.
• Avoid spicy or fatty foods, caffeine and alcohol — and any other food that appears to trigger more acid for you.
  

There is no cure for scleroderma — only treatments that can manage symptoms. GERD symptoms usually respond well to treatment, so don’t hesitate to seek out a gastroenterologist if you have reflux or heartburn in addition to scleroderma.

Source: Everyday Health.com