Gastrointestinal Problems (Question & Answer)by Philip Clements, M.D., UCLA School of Medicine, Department of Rheumatology, (originally published in Scleroderma Voice, Spring 2001) Q. I am responding to Mr. M.N., whose email question was published in the Summer 2000 issue, and Ms. S.B. of New York City, whose letter was published in the Fall 2000 issue. I was treated for years by a rheumatologist, for problems including diarrhea, gas, and fecal leakage. The rheumatologist had me on antibiotics (two weeks on, two weeks off), but nothing ever worked. I started to bleed from my colon and was referred to a gastroenterologist. He knew right away I had CREST, did a colonoscopy, and gave me Asacol. Since then I have been living a good life. Now I take Asacol three times a day (which equals six pills). When I get diarrhea, I take two Imodium pills. No more problems. There is information about Asacol on the web at www.living-better.com. Ms. L.A., Alison Viejo, Calif. A. A medication call sulfasalazine (actually a chemical combination of sulfapyridine and mesalamine) was introduced more than 50 years ago to treat rheumatoid arthritis. It was later found to be effective for inflammatory bowel diseases (i.e., regional enteritis or Crohn's disease and ulcerative colitis). Mesalamine, an anti-inflammatory medication, is the active ingredient in Asacol. There is little evidence to suggest that inflammatory bowel disease is a usual complication of scleroderma. This does not mean that someone with scleroderma could not also have inflammatory bowel disease, but having both disorders would be unusual. Other causes of bowel complaints, in healthy persons or persons with scleroderma, include lactose intolerance, microscopic colitis or gluten sensitivity, which can complicate gastrointestinal complaints (i.e., bloating, diarrhea, gas, etc.) that are part of scleroderma bowel disease. Anyone who has resistant gastrointestinal problems should see a gastroenterologist with experience in systemic sclerosis. The gastrointestinal problems of systemic sclerosis, as well as the other GI disorders I mentioned above, can be diagnosed with appropriate tests. Appropriate management can then be instituted. Although this person may have had a good response to Asacol, it does not mean that this is an appropriate treatment for everyone with systemic sclerosis. A trip to the gastroenterologist can help decide that for each individual. |