Gastroparesis/Scleroderma

[lpp12]

I was diagnosed until GP after a year of reflux.  My emptying time was 938 minutes.I do not have very many problems except eflux which is usually controlled by ppi’s.I had a bout of severe constipation out of the blue in January. Up to then, I was a very regular. My GI doctor told me to do a Fleet enema which worked.Since that day,I can not feel when I need to have a bm.Sometimes I can feel pressure, sometimes not.I can not feel the feces come out of my rectum and need to look to see if I actually went. My GI doctor told me to take Miralax daily but am I not sure I should bc I can go regularly. What could cause this to come on so quickly? It has been almost 2 months and it hasn’t improved.  Are there any tests I should request?Also, I am wondering if I have Systematic Scleroderma.  I do not have any skin issues at all. My hands are always cold;they do not change color or get painful.  My right foot is always swollen on the top of my foot and 3 middle toes only.  I have had this on and off for years and my GP doctor gave my a water pill to take. He thought I may have poor circulation in my leg.   In the past, it would take care of the problem and  the morning after rest, my foot would be fine until the next night.  Exercise seems to aggravate the swelling. The past 2 months,nothing make a difference.  It is not at all painful or uncomfortable. I have very fine groups of blood vessels on my face in small groups (2 groups; one on each check and a slightly red nose where I can see vessels).  I can not see them unless I use a magnifying mirror.   Could this be telangiectasia?  Besides the bowel movement question, my other questions are would gastroparesis present itself in SS without more symptoms? My GI doctor scoped me and did a biopsy of my stomach and intestine, all of which came back normal. Would Sclero be detected by the biopsy? Would my issue with bowel movements come on so quickly if it were Sclero?  Should I be concerned this is Sclero or anything else?

[sookie59]

A related discussion, Is There Any Help For People Suffering From Gastroparesis? was started.

[lpp12]

What tests should I request regarding the bowel movement issue?  I think it is very unusual that I had this problem after one bout of constipation.  Could that happen so quickly if it were Scleroderma?
Thank you

[Kevin Pho, MD]

I agree with the workup thus far.  

If scleroderma is suspected, bloodwork can be done to test for the specific antibodies associated with the disease.  This can include the anti-centromere, anti-topoisomerase-I (Scl-70), anti-RNA polymerase, or U3-RNP antibodies.  A referral to a rheumatologist can help diagnose the disease if suspected.

Regarding the delayed gastric emptying.  Blood tests should be done to check for diabetes or thyroid dysfunction - as they are associated with gastroparesis.  To treat the delayed emptying itself, medications like erythromycin (which is an antibiotic, but shown to help in these cases), as well as Reglan can be considered.

These options can be discussed with your personal physician.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd