Esophageal disease in progressive systemic sclerosis.

Area of Science:

• Gastroenterology
• Rheumatology
• Internal Medicine

Background:

• Progressive systemic sclerosis (PSS), or scleroderma, is a fibrotic disease affecting skin and internal organs.
• Gastrointestinal involvement is common in PSS, with the esophagus being the most frequently affected organ, leading to symptoms like heartburn and dysphagia.
• Esophageal complications such as Barrett's esophagus and cancer can arise, necessitating diagnostic procedures like endoscopy.

Purpose of the Study:

• To review the diagnosis and management of esophageal disease in patients with progressive systemic sclerosis.
• To discuss the role of diagnostic tools like esophageal manometry and endoscopy.
• To outline current treatment strategies, including lifestyle modifications, pharmacotherapy, and surgical considerations.

Main Methods:

• Literature review of diagnostic and therapeutic approaches for esophageal disease in PSS.
• Analysis of the efficacy of proton pump inhibitors and prokinetic agents.
• Discussion of the controversial aspects of antireflux surgery in this patient population.

Main Results:

• Esophageal manometry is valuable for PSS diagnosis.
• Endoscopy is crucial for ruling out complications like Barrett's esophagus, Candida esophagitis, and cancer.
• Proton pump inhibitors are standard therapy, with optimal dosing strategies under investigation.
• Prokinetic agents, like metoclopramide, can be beneficial in early PSS stages.

Conclusions:

• Esophageal disease is a prevalent and challenging complication of PSS.
• A multimodal approach combining lifestyle changes, pharmacotherapy, and potentially surgery is often required.
• Further research is needed to optimize treatment protocols and surgical decision-making for PSS-related esophageal dysfunction.