The gastrointestinal manifestations of scleroderma: pathogenesis and management.

This case exemplifies the severe gastrointestinal manifestations of scleroderma. Esophageal, gastric, small intestinal, and colonic motility disorders were present. The patient was unable to survive on oral feedings or tube feedings. He was clinically resistant to the pharmacologic stimulation of gastrointestinal motility. After considerable discussion the patient was begun on intravenous hyperalimentation to be performed at home. Approximately 1 hr later, he has done remarkably well. He has maintained his weight and has had only one brief hospitalized for a sepsis most likely related to the intravenous feedings. He is still unable to take oral feedings. Other organs have remained clinically uninvolved, and the skin and joint disease have remained stable. It is our feeling that intravenous home alimentation has provided a useful adjunct to management in this patient with severe gastrointestinal involvement of scleroderma. It is hoped that the newer therapeutic modalities described by Dr. Jimenez may be effective in patients with this disease who can now be nourished parenterally.