Scleroderma is an autoimmune disease involving thickening of the connective tissue. It can affect many parts of the body, most commonly thickening of the skin on the hands and face. It can produce an excessive amount of collagen that causes the hardening of the connective tissues. Connective tissue hardening can also cause damage to the internal organs, such as the lungs, heart, kidneys and gastrointestinal tract. This damage can be life threatening in a small percentage of people, however most cases of Scleroderma are of a mild form.
Apart from the pain and reduced movement caused by thickening and hardening of the skin, symptoms of Scleroderma include pain and reduced movement in the joints, indigestion, diarrhoea and constipation. Raynaudís phenomenon, a condition in which blood flow to the extremities is restricted, is also common in the fingers and toes.
A less common symptom of Scleroderma is Dysphagia, difficulty chewing and swallowing. It is a debilitating symptom which occurs when the tissues of the oesophagus begin to harden and stiffen. This reduces the ability of the oesophagus to move food efficiently from the mouth to the stomach. Hardening of the skin around the throat and jaw can also inhibit mandibular movement or chewing, further complicating dysphagia. Another side effect of oesophageal involvement is gastro oesophageal reflux disease (GERD). Hardening of the tissues of the lower oesophageal sphincter, dividing the oesophagus from the stomach, leads to a decrease in the ability of the sphincter to close efficiently, allowing stomach juices to enter the oesophagus.
There is no cure for Scleroderma, and treatment focuses on easing each individualís symptoms. Regular exercise is recommended to encourage joint mobility and help relieve pain associated with stiff and hardened joints. Activities such as meditation and Tai Chi are also recommended as stress management tools to help deal with the stresses the condition places on everyday life. Medication is available to help ease the effects of Raynaudís Phenomenon, as well as the side effects suffered with the involvement of the lungs, kidneys and gastrointestinal system.
Changes to nutrition, although not acting as a cure, can be involved in the treatment process. Firstly, changes in the connective tissues of the gastrointestinal tract can lead to intermittent bouts of diarrhoea and constipation. Changes in diet can help to prevent or better control these uncomfortable symptoms.
If diarrhoea is an issue, it is recommended to avoid foods that may exacerbate the symptom, such as fatty, spicy or high sugar foods and alcohol. Increase consumption of soluble fibres such as rice, banana, oats and psyllium. These will absorb excess water in the gastrointestinal tract and produce softened stools that will move more slowly.
If constipation is an issue, increasing both soluble and insoluble fibres from fruits, vegetables, oats, whole wheat and wholegrain cereals will help move hardened faeces through the intestinal tract.
If the less common dysphagia is an issue, diet will need to be adjusted depending on severity. Maintaining adequate energy and nutrient intake, despite chewing disability, is important. Food texture will have to be altered. Preparing minced or pureed versions of meals will make swallowing easier as will the addition of gravies and sauces. If the dysphagia is very severe, liquid supplements can be used. A dietitian can help individuals adapt their diet to suit their level of dysphagia and help decide which liquid supplement will best suit.
If GERD is occurring due to oesophageal sphincter involvement, dietary changes will be appropriate. Maintaining an appropriate weight is important. Excess weight around the mid section can increase the pressure placed on the stomach, making reflux symptoms worse. Weight reduction will also lead to less stress being placed on the joints, helping to ease joint pain. Limit consumption of high fat foods, alcohol, caffeine and carbonated drinks, all known to exacerbate reflux. Other foods can have similar effects but tend to vary among individuals. It is not wise to eliminate a large number of foods from the diet, so discuss any concerns with a dietitian who can help to ascertain which foods are likely causing symptoms. Eating small, regular meals is better than larger meals that will take longer to digest. Remain upright after meals and avoid drinking liquids with meals.
Although known as a condition effecting the skin and tissues, a dietitian is a valuable member of the health care team for someone suffering from Scleroderma. With no cure, treatment is targeted at managing symptoms to improve lifestyle, and small dietary changes can have a profound impact on lifestyle improvement.
Added to site on : Monday, 29 October 2012