Dysphagia, reflux and related sequelae due to altered physiology in scleroderma

Abstract

Systemic sclerosis is a connective tissue disease that presents with significant gastrointestinal involvement, commonly in the esophagus. Dysphagia is a common clinical manifestation of systemic sclerosis and is strongly related to esophageal dysmotility. However, there are multiple other contributing factors in each step in the physiology of swallowing that may contribute to development of severe dysphagia. The oral phase of swallowing may be disrupted by poor mastication due to microstomia and poor dentition, as well as by xerostomia. In the pharyngeal phase of swallowing, pharyngeal muscle weakness due to concurrent myositis or cricopharyngeal muscle tightening due to acid reflux can cause disturbance. The esophageal phase of swallowing is most commonly disturbed by decreased peristalsis and esophageal dysmotility. However, it can also be affected by obstruction from chronic reflux changes, pill-induced esophagitis, or Candida esophagitis. Other contributing factors to dysphagia include difficulties in food preparation and gastroparesis. Understanding the anatomy and physiology of swallowing and evaluating systemic sclerosis patients presenting with dysphagia for disturbances in each step can allow for development of better treatment plans to improve dysphagia and overall quality of life.

Keywords: Systemic sclerosis; Esophageal motility disorders; Deglutition; Deglutition disorders; Gastroesophageal reflux; Esophagitis

Core Tip: Systemic sclerosis presents with significant gastrointestinal involvement, with dysphagia being a common clinical symptom. Normal swallowing physiology is broken down into the oral phase, pharyngeal phase, and esophageal phase of swallowing; systemic sclerosis can cause disease processes that affect and disrupt each stage of swallowing. We describe the disruptions to swallowing that occur in each phase and potential therapeutic options to alleviate symptoms.