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      Gastrointestinal Manifestations, Malnutrition, and Role of Enteral and Parenteral Nutrition in Patients With Scleroderma.

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          Abstract

          Scleroderma (systemic sclerosis) is an autoimmune disease that can affect multiple organ systems. Gastrointestinal (GI) involvement is the most common organ system involved in scleroderma. Complications of GI involvement including gastroesophageal reflux disease, small intestinal bacterial overgrowth, and chronic intestinal pseudoobstruction secondary to extensive fibrosis may lead to nutritional deficiencies in these patients. Here, we discuss pathophysiology, progression of GI manifestations, and malnutrition secondary to scleroderma, and the use of enteral and parenteral nutrition to reverse severe nutritional deficiencies. Increased mortality in patients with concurrent malnutrition in systemic sclerosis, as well as the refractory nature of this malnutrition to pharmacologic therapies compels clinicians to provide novel and more invasive interventions in reversing these nutritional deficiencies. Enteral and parenteral nutrition have important implications for patients who are severely malnourished or have compromised GI function as they are relatively safe and have substantial retrospective evidence of success. Increased awareness of these therapeutic options is important when treating scleroderma-associated malnutrition.

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          Author and article information

          Journal
          J. Clin. Gastroenterol.
          Journal of clinical gastroenterology
          Ovid Technologies (Wolters Kluwer Health)
          1539-2031
          0192-0790
          Aug 2015
          : 49
          : 7
          Affiliations
          [1 ] *Center for Human Nutrition ∥Department of Rheumatological and Immunological diseases, Cleveland Clinic, Cleveland, OH †College of Osteopathic, Michigan State University, East Lansing, MI §Nutrition Support Consultant, St. Louis, Missouri ‡Department of Gastroenterology/Hepatology, McMaster University, Hamilton, Ontario, Canada.
          Article
          10.1097/MCG.0000000000000334
          25992813

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