Gastrointestinal Problems (Question & Answer)
by Philip Clements, M.D., UCLA School of Medicine,
Department of Rheumatology, (originally published in
"Scleroderma Voice," Spring 2001)
 |
| Philip
Clements , M.D., M.P.H. |
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. |
