Medical Health Encyclopedia

Complications in Upper GI Tract.

• Gastroesophageal reflux disorder (heartburn and trouble swallowing) is a common problem and much more severe than in the general public. This develops when the scarring develops in muscles in the esophagus so that they lose motility and are unable to contract normally. There is some suggestion that patients with severe GERD may inhale in microscopic amounts of stomach acid, which in turn may be a major cause of lung scarring.
• About 80% of patients also experience impaired stomach activity, with a delay in stomach emptying being very common.
• Some patients develop "watermelon stomach" (medically referred to as CAVE syndrome), in which the stomach develops streak red areas from dilated blood vessels. This causes a slow bleeding that can cause anemia over time.
• There may be a higher risk for stomach cancer.

Complications in the Lower GI Tract. Complications in the lower tract can develop but are uncommon. They can include the following:

• Scarring can cause obstruction and constipation. In rare cases, constipation can become so severe that the bowel becomes perforated, which can be life threatening.
• Scarring can also impair intestinal absorption of fats (malabsorption). This can lead to bacteria proliferation that causes watery diarrhea.
• Fecal incontinence (the inability to control bowel movements) may be more common than studies indicate, since patients are reluctant to report it.

Many patients, however, have few or even no lower gastrointestinal symptoms.

Impact on Quality of Life

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Needless to say, the many complications of scleroderma can have a major impact on the person's sense of well being. Patients are greatly concerned about changes in their appearance, particularly alterations caused by tightening of the facial skin. A 2002 study on scleroderma patients reported that 63% experienced at least mild pain and half of them had mild depression or greater. Depression had the greatest impact, even more than pain, in reducing their ability to function socially.

Other Complications

Other complications may include the following:

• Patients with CREST may be at increased risk for biliary cirrhosis, an inflammatory autoimmune disorder of the liver.
• Nerve damage may occur in the extremities (legs and feet, arms and fingers) causing numbness and pain, which can be progressive and lead to severe ulcerations, particularly in the hands. The feet are less often affected, but when they are, the disease tends to affect the joints and cause pain.
• Bone loss (osteoporosis) can occur because of impaired blood flow.
• About half of patients develop hypothyroidism.

Click the icon to see an image of hypothyroidism.

• Impotence usually due to Peyronie's disease (scarring of the penis) may be one of the first complications of the disease in men.
• There some evidence of changes in the elastic properties of large arteries, such as those leading into the legs and up to the brain, in patients with scleroderma. Such changes theoretically increase the risk for stroke; current evidence does not reveal an elevated risk.
• Some studies using imaging techniques have found changes in brain tissue, but because the brain has little connective tissue, scleroderma appears to have little effect on mental functioning, except possibly in late stages of severe disease.
• Systemic scleroderma does not generally affect fertility in women. Pregnant women with scleroderma, however, have a slightly increased risk of premature birth and low birth weight babies.