Management for gastric and small bowel dysmotility in systemic sclerosis
In systemic sclerosis, delayed gastric emptying gastroparesis with nausea and bloating, and impaired intestinal transit, may respond to domperidone; use:
domperidone 10 mg orally, 3 times daily before meals; maximum 30 mg daily1. domperidone domperidone domperidone
Nonspecific loose bowel motions or diarrhoea is frequent in patients with systemic sclerosis. It is best managed with a trial of avoiding irritant foods (in consultation with a dietitian), and further investigation of the potential cause.
Frequent loose, foul-smelling, fatty bowel motions suggest small intestinal malabsorption with bacterial overgrowth. Small intestinal bacterial overgrowth (SIBO) is a common problem for people with systemic sclerosis, and is associated with bloating, diarrhoea, nausea and abdominal discomfort. Refer people with SIBO to a gastroenterologist for management; intermittent or rotating antibiotic therapy may be usedKowal-Bielecka, 2017. For more details, see Small intestinal bacterial overgrowth.
Severe malabsorption with refractory weight loss may require parenteral nutrition in consultation with a specialist centreDenton, 2017.
Bleeding from vascular ectasia may occur in the stomach or intestine and is associated with anaemia, fatigue and weaknessDenton, 2017. Treatment for vascular ectasia involves repeated endoscopic argon laser treatment. Refer people with gastrointestinal bleeding to a gastroenterologist.