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Gastroenterology


Answer 7
  1. Aggressive antireflux regimen. Patients with scleroderma often develop severe esophageal hypomotility and a hypotensive lower esophageal sphincter, which often leads to gastroesophageal reflux and esophagitis. An aggressive antireflux regimen with PPIs can treat this patient’s reflux esophagitis and reduce the risk of developing an esophageal stricture as a consequence of unchecked esophagitis. Surgical fundoplication may worsen dysphagia and is not recommended. A gastrostomy tube would not improve this patient’s reflux and would not allow the patient to eat. Calcium channel blockers may help patients with spastic esophageal disorders but are of little use in patients with scleroderma.

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