Treatment of Bowel Dysfunction in Scleroderma
The gastrointestinal tract is affected in the 70-90% of scleroderma patients1 and typical symptoms include constipation, diarrhoea and faecal incontinence. These symptoms are often not discussed by the patient due to embarrassment, and may not be effectively managed as the cause is not well understood and treatments are not always effective. Dr Anton Emmanuel, who works in the Department of Gastroenterology and Nutrition at University College London, undertook two studies relating to bowel dysfunction in scleroderma between 2012 and 2015.
Posterior tibial nerve stimulation (PTNS) was trialled for the treatment of faecal incontinence due to muscle abnormalities. Sacral nerve stimulation, where the bowel nerves are stimulated by electrical impulses from an implant in the buttock, has shown some benefits in scleroderma, however it is not widely available and is invasive. As PTNS is less invasive – a nerve in the lower leg is stimulated with a small needle – and is effective in treating constipation and incontinence in people without scleroderma. This pilot study evaluated whether PTNS would be suitable for patients with faecal incontinence related to scleroderma. Patients receiving PTNS in the pilot study had a reduction in the number of faecal incontinence episodes and improved symptom scores compared to those who had placebo stimulation (with no current).
Constipation in scleroderma is common but is poorly responsive to laxative treatment, which worsens bloating and pain and predisposes people to faecal incontinence. Prucalopride is a non-laxative treatment that accelerates the rate of movement through the gut by acting on nerves and muscle in the intestine. It is currently licensed for constipation in women. If it proves effective against placebo in a trial in scleroderma patients, it could reduce referrals for more invasive treatments for constipation such as rectal irrigation and manual dis-impaction or surgery.