| Gastrointestinal Involvement (Main Menu) |
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| Esophageal (Throat) Involvement |
| These symptoms may occur in systemic scleroderma but not in localized scleroderma, such as Linear and Morphea. See Types of Scleroderma. This page was written by Shelley Ensz, and has not yet been medically edited. Scleroderma (SD) affects everyone differently. Just because something is listed here does not mean an individual patient will ever experience it. See Disclaimer. |
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| Air Esophagogram |
| Air in the esophagus is a very unusual x-ray finding, and particularly, when it's not associated with a fluid level. Such is indicative of a stricture and should strongly suggest Scleroderma. "This radiological sign, although rare, should suggest Scleroderma and may be particularly useful in patients with "systemic sclerosis sine scleroderma." (1) |
| Barrett's Esophagus |
| Barrett's esophagus. The past year has brought many advances in the epidemiology and endoscopic treatment of those with Barrett's esophagus. PubMed. Curr Opin Gastroenterol. 2006 Jul;22(4):406-11. |
| FDA Approves KAPIDEX (dexlansoprazole) Delayed-Release Capsules For The Treatment Of GERD. The U.S. Food and Drug Administration (FDA) approved KAPIDEX™ (dexlansoprazole) delayed release capsules for the once-daily, oral treatment of heartburn associated with symptomatic non-erosive Gastroesophageal Reflux Disease (GERD), the healing of erosive esophagitis (EE) and the maintenance of healed EE. Medical News Today 02/03/09 (Also see: GERD) |
| Vegetable and fruit intakes and risk of Barrett's esophagus in men and women. The results of this study support previous findings that increased intakes of vegetables and of vegetables and fruit are associated with a lower risk of BE in men and women. Prospective data that examine relations between diet and Barrett’s esophagus are needed. O. M. Thompson, Am J Clin Nutr. January 14, 2009. |
| Radiofrequency Ablation (RFA) of Barrett's Esophagus (BE): Short-Term Results. Short-term results show that RFA is safe for BE and achieves 100% replacement of intestinal metaplasia. RFA combined with fundoplication may be offered to patients with BE and medically refractory reflux symptoms. Long-term endoscopic surveillance is needed to determine if the risk of cancer is reduced with this bimodality therapy. S. M. Eldaif, MD. Ann Thorac Surg 2009;87:405-411. |
| Black Raspberries Protect Against Cancer: New Study Finds Black Raspberries Help Barrett's Esophagus Patients. A new study showed that black raspberries helped many patients reverse the negative impact of reflux acid. Nearly 4 in 10 saw a boost in a protective enzyme and 6 in 10 saw a decline in oxidative stress, which can cause cell damage. Medical News Today. 02/15/09. (Also see: GERD) |
| New techniques improve imaging quality, not diagnosis of Barrett's esophagus. When the enhancement techniques were compared with regular WLE images, the observers clearly preferred the enhancement techniques, which scored higher in terms of overall image quality, the quality of mucosal imaging, and the quality of vascular imaging. EurekAlert! 03/11/08. |
| Camera in a pill offers cheaper, easier window on your insides. This scanning device rather than an endoscope is cheap because it's so small it doesn't require anesthesia and sedation, UWNews.org. 01/24/08. |
| New Treatment Offered For Damaged Esophagus. Interventional gastroenterologists at Rush now offer a noninvasive ablation (removal of harmful tissue) procedure to treat Barrett's esophagus, a precancerous condition in which a thin layer of tissue lining the lower esophagus is damaged due to chronic acid reflux. Medical News Today. 09/14/07. |
| Investigators Uncover Intriguing Clues To Why Persistent Acid Reflux Sometimes Turns Into Cancer. "The research supports why it is important to prevent reflux, because the more reflux you have and the longer you have it, the more it might predispose you to getting Barrett's esophagus. So you want to suppress that reflux," said Dr. Rhonda Souza. Medical News Today. 08/13/07. (Also see: GERD) |
| Heartburn-related Cancer is curable. The clinical picture of esophageal cancer is changing, and so is the traditionally bleak prognosis for the disease, new research suggests. WebMD 04/17/06. |
| Photodynamic therapy is an alternative to removal of Esophagus. Over time, untreated GERD damages the lining of the esophagus and could result in Barrett’s esophagus. Photodynamic therapy could become the first line of treatment, or a more widely used alternative to esophagectomy. University of Kentucky News. 04/05/06. |
| HSR Pioneers Procedure. The Hospital of Saint Raphael (HSR) became one of the first medical centers in New England to successfully perform Minimally Invasive Esophagectomy (MIE), which provides for better patient outcomes and shorter recovery times for esophageal cancer, Barrett's esophagus, scleroderma and achalasia. Business New Haven. 12/26/05. |
| Prevalence of Barrett's Esophagus in Systemic Sclerosis. We found a prevalence of 12.5% of Barrett’s esophagus. This seems to be quite similar to the prevalence found in patients with chronic reflux without systemic sclerosis. We did not find any patients with adenocarcinoma but 3/13 (23%) had dysplasic metaplasia. J. Wipff. FRI0061 EULAR 2005. |
| Carol Langenfeld: Diffuse Scleroderma (Carol is co-author of the book Living Better : Every Patient's Guide to Living with Illness) People tell me that I have earned my credentials as a "certified patient" the hard way... |
| Don Alfera: CREST, Pulmonary Fibrosis and Sjögren's I entitled this "My Time So Far" since this has been a journey unlike any that I could have ever tried to imagine in my life... |
| Jerri: CREST Syndrome I was twenty-one years of age when I first noticed that my fingers, toes and lips were turning colors... |
| Sharon: CREST with Limited Scleroderma, Sjögren's and Pulmonary Hypertension (Australia) Day by day I discover another food I cannot eat... |
| Candida Esophagitis |
| The "Foamy" Esophagus A Radiographic Sign of Candida Esophagitis. Shows sophagrams of scleroderma patients. American Journal of Roentgenology. |
| Severe Esophageal Candidiasis In An Immunocompetent Patient. Candida esophagitis results from fungal overgrowth of the esophagus, impaired cell-mediated immunity, or both. Fungal overgrowth typically occurs in the setting of esophageal stasis resulting from abnormal esophageal motility (eg, achalasia or scleroderma) or mechanical causes (eg, strictures). The Internet Journal of Infectious Diseases. |
| Correlation with Lung Disease |
| Clinical features of scleroderma patients with contracture of phalanges (CP). Our study suggested that the presence of CP may be a marker of oesophageal involvement, pulmonary fibrosis and heart involvement. PubMed Clin Rheumatol. 2007 Aug;26(8):1275-7. (Also see: Joint Contractures, Pulmonary fibrosis, Cardiac Involvement) |
| Clinical features of scleroderma patients with contracture of phalanges (CP). The study suggested that the presence of CP may be a marker of oesophageal involvement, pulmonary fibrosis and heart involvement. PubMed. Clin Rheumatol. 2006 Dec 15. (Also see: Muscle and Joint Involvement, Pulmonary Fibrosis, and Cardiac Involvement) |
| Esophageal Involvement is Correlated with Interstitial Lung Involvement (ILD) in Systemic Sclerosis (SSc) Patients. In our study, 100% of 25 unselected SSc patients showed some degree of GE disease by manometry. A significant correlation was shown between manometric parameters and the reduction of total lung capacity and DLCO. E. Vesprini. FRI0104 EULAR 2005. (Also see: What is Scleroderma?, Aspiration Pneumonia, and Pulmonary Fibrosis) |
| Dysphonia (Hoarseness, Loss of Voice) |
| Achalasia in circumscribed scleroderma. The association of achalasia and circumscribed scleroderma could possibly be based on common autoimmune mechanisms and an analogous pathogenesis with resulting fibrosis. PubMed. Dtsch Med Wochenschr. 2006 Aug;131(33):1799-802. |
| Evaluation of Dysphonia in Patients with Scleroderma with Videolaryngostroboscopy. Scleroderma affects the larynx and causes the dysphonia. This could be due to the over production of the extracelular matrix and the oedematous stage of the disease. There is still a need of a large series to show the types of the laryngeal pathology. M. Tezer. FRI0326 EULAR 2004. |
| Dysphonia (Hoarseness, Loss of Voice) Personal Stories |
| Leeben: Limited Scleroderma and CREST I had a traumatic forty-five-minute intubation and landed up in the ICU with problems breathing and paralyzed vocal cords. It has been the most devastating thing for me, since the loss of of my voice has caused social isolation and dependence... |
| Esophageal Diseases |
| A case-control study of the pathology of esophageal disease in systemic sclerosis (scleroderma). The loss of circular and longitudinal smooth muscle in the distal scleroderma oesophagus may represent loss of normal neural function followed by secondary tissue atrophy, or may be a primary smooth muscle lesion. PubMed. Gut. 2006 Dec;55(12):1697-703. |
| Open Esophagus on HR-CT Scan is Predictive for SSc. An open esophagus on a HR-CT scan, performed for whatever reason has a high positive predictive value for SSc and should prompt further examinations to confirm or exclude this diagnosis. M. C. Vonk. SAT0260 EULAR 2006. |
| Esophageal manometry in early and definite systemic sclerosis. The correlation between LES (lower esophageal sphincter) abnormalities and FVC (forced vital capacity) suggests a possible causal relationship between these disease manifestations. PubMed. Clin Rheumatol. 2004 Dec 9. |
| Radionuclide Gastroesophageal Motor Studies. The role of radionuclide gastroesophageal motor studies is clearly identified in the various steps of patients' management, from the initial diagnostic approach to functional characterization to postoperative follow-up or monitoring of medical therapy. PubMed. J Nucl Med. 2004 Jun;45(6):1004-1028. |
| Esophageal Dysfunction in Patients with Definite and Early Systemic Sclerosis. Esophageal manometry can detect abnormalities in a sizeable proportion of patients with early SSc not fulfilling the ACR criteria, including asymptomatic patients. The correlation between lower esophageal sphincter abnormalities and Forced Vital Capacity suggests a possible causal relationship between these disease manifestations. P. Airo'. FRI0285 EULAR 2004. (Also see: Pulmonary Involvement) |
| The diagnostic value of oesophageal transit scintigraphy for evaluating the severity of oesophageal complications in systemic sclerosis. An oesophageal scan can detect both slight and severe types of oesophageal dysfunction, and can be used as a quantitative method that reflects functional abnormality in SSc. PubMed. Nucl Med Commun. 2004 Apr;25(4):375-381. |
| Bacteria live in the esophagus! The esophagus isn't merely a tube for food traveling from the mouth to the stomach, it also provides an environment for bacteria to live, according to a new study by NYU School of Medicine scientists that overturns the general belief that the esophagus is free of bacteria. EurekAlert 03/05/04. (Also see: Heartburn) |
| Chest Pain, Chronic Many different types of problems can cause discomfort, shortness of breath, pain with swallowing, and many other symptoms in the chest area. This chart may help you pinpoint your problem as you confirm your symptoms. familydoctor.org |
| Digestive System Diseases Karolinska Institute library |
| Esophageal Motility Disorders |
| Abnormal Propulsion of Food. The movement of food from mouth to stomach requires normal and coordinated action of the mouth and throat, propulsive waves of the esophagus, and relaxation of the sphincters. A problem with any of these functions can cause difficulties. Merck. |
| An analysis of distal esophageal impedance in individuals with and without esophageal motility abnormalities. Our results suggest that evaluation of distal esophageal impedance may assist in recognition and diagnosis of esophageal motility abnormalities. Blonski W. (PubMed). J Clin Gastroenterol. 2008 Aug;42(7):776-81. |
| An analysis of distal esophageal impedance in individuals with and without esophageal motility abnormalities. Our results suggest that evaluation of distal esophageal impedance may assist in recognition and diagnosis of esophageal motility abnormalities. Blonski W. (PubMed) J Clin Gastroenterol. 2008 Aug;42(7):776-81. |
| Non-achalasic motor disorders of the oesophagus. Motor abnormalities of the oesophagus are characterised by a chronic impairment of the neuromuscular structures that co-ordinate oesophageal function. Sifrim D. PubMed. Best Pract Res Clin Gastroenterol. 2007;21(4):575-93. |
| Esophageal disease in scleroderma. Motility studies in patients with scleroderma show reduced-amplitude or absent peristaltic contractions in the distal two-thirds of the esophagus and normal or decreased lower esophageal sphincter pressure. PubMed. J Clin Gastroenterol. 2006 Oct;40(9):769-75. |
| Initial experience with magnetic resonance fluoroscopy in the evaluation of oesophageal motility disorders. Comparison with manometry and barium fluoroscopy. Our work demonstrates that MR fluoroscopic examination in subject affected by oesophageal motility disorders is feasible and can properly depict motility and morphology alterations, achieving correct diagnosis in the majority of cases. PubMed. Eur Radiol. 2006 Apr 26. |
| (PDF) Laryngeal assessment in rheumatic disease patients. Laryngeal abnormalities were seen in 11 of 12 patients with lupus, in all 11 patients with scleroderma and in 3 patients with mixed connective tissue disease. Vocal fold bamboo node was observed in 5 patients and 92.3% of all patients presented laryngeal signs of gastroesophageal reflux disease. Rev Bras Otorrinolaringol. V.71, n.4, 499-503, jul./aug. 2005. |
| Metoclopramide response in patients with early diffuse systemic sclerosis. Effects on esophageal motility abnormalities. The results of our study show that metoclopramide may improve LES (lower esophageal sphincter) pressures in patients with early and late dSS. Because metoclopramide can be used orally, it may mitigate both dysphagia and heartburn. PubMed. Clin Exp Rheumatol. 2005 Sep-Oct;23(5):685-8. (Also see: Dysphagia and Heartburn) |
| Radiographic evaluation of esophageal function. Performing studies of the highest technical quality yields the most definitive results. Motility disorders such as achalasia and scleroderma have specific radiographic findings. PubMed. Gastrointest Endosc Clin N Am. 2005 Apr;15(2):231-42. |
| Esophageal dysmotility in scleroderma patients with different disease forms and ANA patterns: a scintigraphic study in 100 cases. The scintigraphy confirms to be a useful and non invasive diagnostic method; moreover it permits to quantify the severity of the esophageal dysmotility by analyzing both global and segmental function. PubMed. Reumatismo. 2003;55(2):86-92. |
| Interstitial lung disease (ILD) in Systemic Sclerosis (SSc) and its Association with Esophageal Motility Disturbance. Our single center study suggests a positive correlation of digital infarct with ILD in diffuse SSc and a positive correlation of esophageal motility disturbance and ILD; but there was no effect on severity of ILD in SSc patients and no difference in severity of ILD in diffuse and limited cutaneous SSc. R. Gupta. AB0333 EULAR 2003 (Also see: Pulmonary Involvement) |
| Esophageal Motility Stories |
| Annette G: MCTD, Systemic Scleroderma, Chronic Kidney Disease, CFS, Fibromyalgia, Trigeminal Neuralgia, TMJ People think that because I am a nurse I have all the answers. Well guess what? I don't... |
| Dawn M: Linear/Systemic Scleroderma My family
and I were informed by the doctors, that the localized/linear form of scleroderma that I was diagnosed with, would never progress into the
potentially fatal, systemic form... |
| Esophageal Spasm |
| Esophageal spasms. Esophageal spasms are an uncoordinated series of muscle contractions that prevent food from traveling properly from your esophagus to your stomach. These spasms can be very painful. Chest pain is a common symptom of esophageal spasm. Mayo Clinic. |
| Esophageal Spasm. Esophageal spasm can be subdivided into 2 distinct entities: (1) diffuse esophageal spasm (DES), in which contractions are uncoordinated, and (2) nutcracker esophagus, in which contractions proceed in a coordinated manner, but the amplitude is excessive. eMedicine. 07/10/07. |
| Esophageal Stricture |
| Esophageal Stricture is an abnormal narrowing of the esophagus. |
| See Medical Tests: Esophageal Dilation |
| Radiologic diagnosis of benign esophageal strictures: a pattern approach. When esophageal strictures are detected at barium examination, the underlying cause can often be determined with a pattern approach that takes into account the clinical history, the appearance and location of the strictures, and the presence of other associated radiographic findings. PubMed. Radiographics. 2003 Jul-Aug;23(4):897-909. |
| Esophageal Stricture Personal Stories |
| Judy R. Thompson Devlin: Diffuse Scleroderma with CREST He said 1 in 200 people get a disease in their lifetime, and that scleroderma was like having 20-30 diseases at once... |
| Lorrie: Limited Scleroderma/CREST At first I thought, "Oh my goodness! I am going to die." But my doctor assured me that I could very likely live to be an old woman... |
| Lynsey: Daughter of Patient with Scleroderma and Lupus My mother has had all but four fingers amputated, all of her toes on her left foot and her right leg up to her knee has been amputated... |
| Esophageal Ulcer |
| Esophageal Ulcer is an open sore in the esophagus. |
| Frequency and Characteristics of Esophageal Lesions in Systemic Sclerosis (SSc) According to the Data of Endoscopy. Endoscopic signs of esophageal involvement were found in the majority of patients with SSc, including serious lesions (erosions and ulcers). A. E. Karateev. FRI0362 EULAR 2006. |
| A case-controlled study of the pathology of esophageal disease in systemic sclerosis (scleroderma). The loss of circular and longitudinal smooth muscle in the distal scleroderma esophagus may represent loss of normal neural function followed by secondary tissue atrophy, or may be a primary smooth muscle lesion. PubMed. Gut. 2006 Mar 9. |
| Gastric MALT Lymphoma |
| Systemic sclerosis and gastric MALT lymphoma. MALT (mucosa-associated lymphoid tissue) lymphomas are usually confined to the gastric wall. Gastric MALT lymphomas have a well-established association with H. pylori infection. Eradication of H. pylori is the mainstay of treatment. PubMed. Joint Bone Spine. 2005 Jun 30. (Also see: Scleroderma and Cancer) |
| Reflux (Heartburn) |
| Reflux (heartburn) occurs when acid from the stomach backs up into the esophagus (throat). See Reflux (Heartburn) by ISN. |
| Hoarseness:Reflux (heartburn) is a frequent cause of dysphonia (hoarseness or loss of voice) in scleroderma. |
| Esophageal Involvement in Scleroderma: Gastroesophageal Reflux, the Common Problem. Esophageal involvement is frequent in SSc patients. Appropriate treatment of esophageal involvement ameliorates symptoms and prevents complications. PubMed. Semin Arthritis Rheum. 2006 Oct 10. (Also see: Reflux, Heartburn, GERD) |
| A Role of Helicobacter Pylori Infection in Gastroesophageal Reflux Disease (GERD) in Patients with Systemic Sclerosis (SSc). GERD is the most common gastrointestinal tract disease in SSc. H.pylori infection might play an important role in its severity. H. Kuno. AB0279 EULAR 2006. (Also see: GERD) |
| Laparoscopic fundoplication in patients with an aperistaltic esophagus and gastroesophageal reflux. Patients with troublesome reflux and an aperistaltic esophagus can be effectively treated by laparoscopic fundoplication. An acceptable outcome will be achieved in the majority of patients. PubMed. Dis Esophagus. 2006;19(2):94-8. |
| References |
| (1) Air esophagogram and intestinal pseudoocclusion in a patient with scleroderma. J Rheumatol 1991;18: 897-899; Kraus A, Alarcón-Segovia D, Huddinge University Hospital, Sweden |
