title: Gastrointestinal Manifestations, Malnutrition, and Role of Enteral and Parenteral Nutrition in Patients With Scleroderma.
abstract: Scleroderma (systemic sclerosis) is an autoimmune disease that can affect multiple organ systems. Gastrointestinal (GI) involvement is the most common organ system involved in scleroderma. Complications of GI involvement including gastroesophageal reflux disease, small intestinal bacterial overgrowth, and chronic intestinal pseudoobstruction secondary to extensive fibrosis may lead to nutritional deficiencies in these patients. Here, we discuss pathophysiology, progression of GI manifestations, and malnutrition secondary to scleroderma, and the use of enteral and parenteral nutrition to reverse severe nutritional deficiencies. Increased mortality in patients with concurrent malnutrition in systemic sclerosis, as well as the refractory nature of this malnutrition to pharmacologic therapies compels clinicians to provide novel and more invasive interventions in reversing these nutritional deficiencies. Enteral and parenteral nutrition have important implications for patients who are severely malnourished or have compromised GI function as they are relatively safe and have substantial retrospective evidence of success. Increased awareness of these therapeutic options is important when treating scleroderma-associated malnutrition.
authors.affiliation: *Center for Human Nutrition ∥Department of Rheumatological and Immunological diseases, Cleveland Clinic, Cleveland, OH †College of Osteopathic, Michigan State University, East Lansing, MI §Nutrition Support Consultant, St. Louis, Missouri ‡Department of Gastroenterology/Hepatology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Shishira
authors.initials: S
authors.lastname: Bharadwaj
authors.forename: Parul
authors.initials: P
authors.lastname: Tandon
authors.forename: Tushar
authors.initials: T
authors.lastname: Gohel
authors.forename: Mandy L
authors.initials: ML
authors.lastname: Corrigan
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Coughlin
authors.forename: Abdullah
authors.initials: A
authors.lastname: Shatnawei
authors.forename: Soumya
authors.initials: S
authors.lastname: Chatterjee
authors.forename: Donald F
authors.initials: DF
authors.lastname: Kirby
mesh_terms: D018450:Disease Progression; D004750:Enteral Nutrition; D005355:Fibrosis; D005767:Gastrointestinal Diseases / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D044342:Malnutrition / Q000209:etiology / Q000628:therapy*; D010288:Parenteral Nutrition; D012595:Scleroderma, Systemic / Q000150:complications* / Q000503:physiopathology