| 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 |
| What is Barrett's Esophagus? Barrett's esophagus is a precancerous condition in which the lining of the esophagus is replaced by abnormal cells. One-third of all people with scleroderma, a skin disorder, develop Barrett's esophagus. For some unknown reason, Barrett's esophagus occurs three times more often in males than in females. Amanda Wattson. 24 Medica. 10/05/09. |
| 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. |
| Carol Langenfeld: Diffuse Scleroderma 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) |
| Dysphonia (Hoarseness, Loss of Voice) |
| Systemic sclerosis (scleroderma) can affect the larynx and cause dysphonia (hoarseness or loss of voice), which can be evaluated with videolaryngostroboscopy. |
| 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. |
| 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. |
| Oesophageal dilatation on HRCT-scan of the lungs as a sign of scleroderma. Oesophageal dilatation as visible on an HRCT-scan of the chest may alert physicians to look for other signs or symptoms of systemic sclerosis (SSc) in these patients, enabling early diagnosis and specific treatment. Ann Rheum Dis doi:10.1136/ard.2007. |
| 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 |
| 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. |
| Oral, pharyngeal and esophageal motility disorders in systemic diseases. This review summarizes the literature on disorders of swallowing in which a reasonable body of literature exists to support an association between oropharyngeal or esophageal motility disorders and a given systemic condition. James L. Wise, M.D. , Goyal & Shaker GI Motility online. 05/16/09. (Also see: Dsyphagia) |
| 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. |
| Esophageal Motility Stories |
| Amanda: Diffuse Scleroderma Systemic Sclerosis I am thirty-nine years old and was diagnosed with diffuse scleroderma systemic sclerosis in August 2007... |
| 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... |
| Mars: Scleroderma with Full Gastrointestinal Involvement I finally started total parenteral nutrition (TPN, or tubal feeding) in May 2010 and it was an absolute success... |
| Sonya D: Surviving Daughter of Systemic Scleroderma Patient (Portugal) She had difficulty eating, drinking and digesting her food, but yet doctors had no clue... |
| 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. |
| 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. |
| Helicobacter Pylori (H. Pylori) Suspected in Oral Bisphosphonate Intolerance, and in Systemic Sclerosis (SSc) Stomach Problems. 47% of patients who cannot tolerate oral bisphosphonates are infected with H. pylori, as are 83% of systemic sclerosis (SSc) patients. Testing for and treating the infection might enable more patients to take oral bisphosphonates and might reduce some of the gastrointestinal problems common in SSc. Musculoskeletal Report, Nov 2008. |
| 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) |
| 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 |
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