Scleroderma oesophagus Home A-Z Health Information Health Library A-Z Scleroderma Oesophagus Overview Scleroderma can cause hardening and thickening of the internal organs, including the oesophagus. In scleroderma, the smooth muscles of the oesophagus become weakened, leading to impaired peristalsis. Cause Immune dysregulation: This is the primary cause of scleroderma as it is an autoimmune disease, wherein the autoimmune reaction results in oesophageal fibrosis (scarring).Atrophy of oesophageal smooth muscles: In scleroderma, the smooth muscle fibres of the oesophagus undergo atrophy and fibrosis, impairing the ability of the oesophagus to contract effectively. This leads to a loss of normal peristalsis (the coordinated wave-like contractions that move food down the oesophagus).Decreased lower oesophageal sphincter (LES) tone: One of the most significant features of scleroderma oesophagus is a reduction in LES pressure. This can lead to gastroesophageal reflux disease (GERD), as the weakened LES cannot effectively prevent stomach contents from refluxing into the oesophagus. This is often exacerbated by the loss of oesophageal motility.Neuropathy (nerve problem that causes pain): The vagus nerve (which controls oesophageal motility) can be affected by the autoimmune reaction, leading to neuropathy or damage to the neural pathways that control smooth muscle contraction and relaxation. This results in the loss of coordination between muscle layers, leading to disordered motility. This can cause a phenomenon called "hypomotility", where the oesophagus has decreased or absent peristalsis, or "aperistalsis", where the normal peristaltic waves are either absent or ineffective. Symptoms Dysphagia (difficulty swallowing)Heartburn (burning sensation in the upper abdomen)RegurgitationAcid reflux (backflow of stomach acid into the oesophagus)Aspiration can occur in severe cases, i.e., food or liquid can be aspirated into the lungs due to the dysfunction of the swallowing mechanism, which can lead to aspiration pneumonia. Diagnosis Oesophageal manometry: In this test, scleroderma oesophagus may manifest as reduced peristalsis and lower oesophageal sphincter (LES) relaxation.Barium swallow: In this test, the LES may exhibit a bird-beak appearance. Treatment Treatment modalities for scleroderma oesophagus include:Medications:Proton pump inhibitors and H2 receptor blockers: These are used to manage acid reflux.Prokinetic agents: Agents like metoclopramide and domperidone are used to improve oesophageal motility.Stricture dilation: In some cases, stricture dilation may be performed to reduce the pressure on the oesophagus.Oesophageal surgery: This may be necessary in some cases.