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Gastroenterology


Answer 4
  1. Gastroparesis. Scleroderma is a disorder with a variety of gastrointestinal complications, and gastroparesis is common in this setting. It often manifests as dull mid-abdominal pain after meals, as ingested food sits for protracted periods of time as the stomach fails to empty. Patients often report symptomatic improvement after vomiting and will often recognize that their food appears undigested. GERD likely accounts for this patient’s substernal pain, as patients with scleroderma often have esophageal dysmotility and a patulous lower esophageal sphincter, leading to chronic esophageal acid exposure, often with severe esophagitis. Esophageal acid exposure is likely only worsened by vomiting due to gastroparesis. Although many patients with scleroderma have constipation, diarrhea can develop due to bacterial overgrowth resulting from poor motility and proximal migration of colonic flora. Bacterial overgrowth can lead to malabsorption and vitamin deficiencies and is treatable by courses of rotating antibiotics. Although the patient could have biliary colic, her pain would not be expected to improve with vomiting if this were the case.

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