“90% of people with scleroderma will get problems with the gut. It’s the normal, not the exception.”
Dr Inns says the problem can affect any part of the gut, from the mouth to the anus. “We’ve got a lot to talk about today,” he told the seminar.
There’s something about your immune system, Dr Inns says, in the way it sees the tissues in the gut, that leads to an immune response. It cause two levels of damage; both into the muscle layer and the nerves.
The damage happens to the muscle layer and the connective tissues. The nerves that determine how wide and open blood vessels are, are damaged too. It happens in the gut in the same way that those with Raynaud’s experience it in their fingers.
The cycle of damage is exacerbated when blood flow is restricted to the layers of the gut.
The severity of scleroderma in the gut is unrelated to how it affects the rest of the body. It may be severe elsewhere but mild in the gut and it could be seriously affecting the gut but not the rest of the body. It’s one of scleroderma’s uncertainties, he says.
The gut has more nerve endings than the brain. Dr Inns described the complexity of the stomach as almost like it being its own individual creature, over which you have no control. It just gets on with the job most of the time.
“But we certainly know about it when it stops doing its job.” It’s that time when it stops doing its job, that he set out in detail to describe, beginning, when you swallow a meal.
Difficulty Swallowing and reflux
Dysphagia is the medical term for difficulty swallowing. It is associated with scleroderma because the disease damages the nerves and muscles in the oesophagus (American spelling is esophagus).
Swallowing problems may not just be the movement of food. There can be narrowing problems as a consequence of scleroderma.
Food can move from the mouth to the gut because the oesophagus forces it down. “It’s why you can swallow in space.” The oesophagus delivers food into the stomach through a sphincter.
The sphincter holds the food in your stomach. You need to burp and that’s a reflux. Dr Inns says everyone does, it’s normal but while normal reflux quickly settles the food and acid back down into the stomach, the presence of scleroderma can affect the severity.
“If your stomach’s not emptying out very well, then there’s going to be more food and fluid there, every time you reflux.” Big meals cause it too and when you gain weight. Fatty meals slow the stomach emptying down.
Because patients with scleroderma get more reflux, the complications are greater. The frequent effects of stomach acid bathing the oesophagus, causes its lining to become more like that of the acid-resistant stomach. That would seem to make sense but Dr Inns says it can lead to oesophageal cancer, and that’s a cancer that is increasing.
“We are seeing increasing rates of oesophageal cancer compared with most other cancers, which are pretty static, and that’s because we’ve an obesity epidemic and therefore a reflux epidemic,” he says.
There are things you can do and medicines you can take to mitigate the effects of reflux.
Doctors measure the amount of acid that is entering the oesophagus by inserting a catheter down the throat to determine how much acid is present. Patients can push a button when they feel a symptom and correlates with the measurement of acid rising into the oesophagus.
Where once the catheter had to come out the nose for 24 or 48 hours, Dr Inns says in his Boulcott Hospital, it’s monitored wirelessly and much more conveniently.
Steps you can take yourself, Dr Inns says, include:
- Eat small meals
- Avoid eating before sleeping
- Reduce fat intake
- Don’t smoke
As for medicines, Omeprazole, sold under the Losec brand name, seems effective for long-term use. Dr Inns says the discovery of Omeprazole more that thirty years ago made reflux a much more manageable problem.
In a wide-ranging talk, Dr Inns covered the remainder of your digestive system and the effects scleroderma has on it.