Procedures in nutritional care of patients with autoimmune disease are determined by the effects of the disease on damaged organs rather than the effects on the immune system.

Scleroderma is a connective tissue disease that often involves the gastrointestinal tract. It results in decreased peristalsis and lower esophageal sphincter (LES) pressure, possibly as the result of a neural dysfunction and muscle atrophy.

A number of drugs also lower LES pressure. As a result, gastroesophageal reflux and heartburn may occur as a side effect of the drugs used in treatment of other conditions. When patients are receiving these drugs, nutrition care specialists should be alert to the development of reduced LES pressure as a side effect, since it may affect for intake.

A mainstay of drug treatment for gastroesophageal reflux and heartburn is the use of antacids. A mixture of aluminum hydroxide and alginic acid (gaviscon) or acidophilus floats on top of the gastric contents and reduces the tendency to reflux. Aluminum salts combine avidly with bile salts, which are also irritant. Bethanechol Chloride may be used to increase LES pressure in patients who are resistant to antacid and diet treatment. Metoglopropamide may also be prescribed, as well as cimetidine, which decreases acid secretion.

To decrease early signs of heartburn, drink a large glass of water, eat slowly, chew food well, eat more raw vegetables, don’t eat three hours before bedtime; wait three hours after eating before lying down.

Low-fat or non-fat yogurt is nutritious food, and there’s absolutely no harm in consuming the kind with live cultures to replace natural good bacteria back in the digestive tract.

The most common culprit is losing natural, good bacteria in the digestive tract is diarrhea, as well as antibiotic use. To replace this valuable source it is recommended to take acidophilus (liquid or capsules) or yogurt with live cultures.

The general nutritional care in gastroesophageal reflux should be monitored.

• Increase lower esophageal sphincter pressure (LES).
• Increase protein in diet.
• Decrease fat in diet to 45 grams a day.
• Avoid alcohol, peppermint, spearmint.
• Avoid coffee, strong tea, and chocolate (if not well tolerated).
• Use non-fat or 1% milk.

Improve clearing of the esophagus.

• Do not recline for 2 hours after eating.
• Elevate head of bed.

Decrease irritation in the esophagus.

• Avoid irritants: citrus juices and tomato (supplement as necessary), coffee, spicy food, carbonated beverages.
• Avoid any other foods that regularly causes heartburn (may include rich pastry, frosted cakes, processed foods, sugar fried foods.

Decrease frequency and volume of reflux.

• Elevate head of bed.
• Eat small meals, more frequent meals if necessary.
• Reduce weight if overweight.
• Sip only small amounts of fluids with meals.
• Drink most fluids between meals.
• Include enough fiber to avoid constipation (straining increases abdominal pressure).

Nutritional and other considerations.

• Monitor effect of antacids on iron status; supplement if necessary.
• Avoid chewing gum (causes air swallowing).
• Avoid smoking immediately following meals (can cause gastroesophgeal reflux and heartburn.

Children may need natural vitamin supplements while taking medications to help get the USRDA daily requirements. Although this doesn’t treat or cure any disease, please check with a nutritionist for more information.

Please keep in mind, this webpage is for your information only.
Please check with your child's physician for any treatments.

For more information on Juvenile Scleroderma, contact:

Juvenile Scleroderma Network, Inc.
1204 W. 13th Street, San Pedro, CA 90731

Tel: (310)519-9511 (Pacific Time)
24 Hour Support Line: 1-866-338-5892 (toll-free)
Speak to another JSD parent for emotional and logistical support provided by home-based JSD volunteers. For medical advice, please contact your child's physician.

Non-Medical Questions or Comments? Click Here
Medical Questions? The Doctor's In: Q & A