Minireviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2021; 27(31): 5201-5218
Published online Aug 21, 2021. doi: 10.3748/wjg.v27.i31.5201
Dysphagia, reflux and related sequelae due to altered physiology in scleroderma
Anusri Kadakuntla, Ankit Juneja, Samantha Sattler, Anusha Agarwal, Drishti Panse, Nardin Zakhary, Anusha Pasumarthi, Lee Shapiro, Micheal Tadros
Anusri Kadakuntla, Ankit Juneja, Samantha Sattler, Anusha Agarwal, Drishti Panse, Anusha Pasumarthi, Albany Medical College, Albany, NY 12208, United States
Nardin Zakhary, Department of Dentistry, Ministry of Health, Alexandria 21500, Egypt
Lee Shapiro, Division of Rheumatology, Albany Medical Center, Albany, NY 12208, United States
Micheal Tadros, Division of Gastroenterology, Albany Medical Center, Albany, NY 12208, United States
Author contributions: Kadakuntla A, Juneja A, Sattler S, Agarwal A, Panse D, Zakhary N and Pasumarthi A wrote the paper; Kadakuntla A, Juneja A and Sattler S contributed to the figures and tables; Kadakuntla A, Juneja A, Shapiro L and Tadros M made critical revisions; Tadros M approved final version of manuscript to be published.
Conflict-of-interest statement: The authors disclose no conflicts of interest or external funding for this publication.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Micheal Tadros, FACG, MD, Associate Professor, Doctor, Division of Gastroenterology, Albany Medical Center, 43 New Scotland Avenue, Albany, NY 12208, United States. tadrosm1@amc.edu
Received: March 23, 2021
Peer-review started: March 23, 2021
First decision: April 29, 2021
Revised: May 13, 2021
Accepted: July 30, 2021
Article in press: July 30, 2021
Published online: August 21, 2021
Processing time: 148 Days and 5.9 Hours
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.