Esophageal involvement in scleroderma: gastroesophageal reflux, the common problem.
OBJECTIVE
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.
Ntoumazios
Stavros K
SK
Department of Otolaryngology, Medical School, University of Ioannina, Ioannina, Greece.
Voulgari
Paraskevi V
PV
Potsis
Konstantinos
K
Koutis
Evagelos
E
Tsifetaki
Niki
N
Assimakopoulos
Dimitrios A
DA
D004941:Esophagitis / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D004947:Esophagus / Q000473:pathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D012595:Scleroderma, Systemic / Q000150:complications*