Esophageal Involvement in Scleroderma: Gastroesophageal Reflux, the Common Problem

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Objectives

Systemic sclerosis (SSc) is a multisystem disease characterized by abnormalities of small blood vessels, and fibrosis of the skin and internal organs including gastrointestinal tract. This article reviews the esophageal involvement in SSc, emphasizing the gastroesophageal reflux, which is a common problem in SSc patients.

Methods

We conducted a Medline search from 1966 to 2005. The keywords “systemic sclerosis,” “esophageal involvement,” “gastroesophageal reflux,” “esophagitis,” and “treatment” were used.

Results

The gastrointestinal tract is frequently affected in diffuse and limited disease. Although any part of the gastrointestinal tract can be involved, esophageal disease occurs in nearly all patients with SSc. Common esophageal manifestations in SSc include motility abnormalities and gastroesophageal reflux (GER), Barrett’s esophagus, adenocarcinoma, infectious esophagitis, and drug-induced esophagitis. Common complications of GER include esophagitis with erosions and bleeding and stricture formation. Extraesophageal manifestations of GER include mouth ulcers, chronic cough, hoarse voice, sore throat, pharyngitis, laryngospasm, asthma, and recurrent pneumonia. Diagnostic procedures used in the investigation of esophageal involvement include barium esophagram, esophageal manometry, 24-hour ambulatory pH, and endoscopy. Treatment of GER in SSc includes behavioral modification and medical therapy, mainly with proton pump inhibitors. Surgical intervention has a limited role in the management of GER in selected SSc patients.

Conclusions

Esophageal involvement is frequent in SSc patients. Gastroesophageal reflux may cause high morbidity. Careful examination of the patients reveals gastrointestinal abnormalities even in patients without symptoms. Appropriate treatment of esophageal involvement ameliorates symptoms and prevents complications.

Section snippets

Methods

This review is based on a Medline literature search from 1966 to 2005. The keywords “systemic sclerosis,” “esophageal involvement,” “gastroesophageal reflux,” “esophagitis,” and “treatment” were used. Articles obtained from this search were reviewed for additional references.

Gastrointestinal Manifestations of Scleroderma

Gastrointestinal tract dysfunction is one of the most common problems in SSc and is found in diffuse and limited disease (5). Up to 90% of patients with SSc have been estimated to have gastrointestinal involvement (6, 7, 8, 9) causing high morbidity and, in rare cases, mortality. In various studies gastrointestinal involvement in SSc fluctuates between 55 and 82% (10, 11, 12, 13). No significant correlations were found between gastrointestinal manifestations and gender, age at diagnosis of SSc,

Discussion

The esophagus is the most frequently affected part of the gastrointestinal tract in SSc. GER is a common problem and may be associated with complications and extraesophageal manifestations. Careful examination of patients reveals esophageal involvement even in those without symptoms. Behavioral modification and medical therapy are essential for GER treatment in SSc, while surgical intervention has limited value in selected SSc patients. Early medical treatment is essential not only to improve

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