Scleroderma esophagus

Introduction

Introduction to scleroderma esophagus

Sclerodermalesophagus refers to the kinetic abnormalities of scleroderma involving the esophageal muscle layer. Scleroderma is a connective tissue disease that affects fibrous tissue and small blood vessels of multiple organs. When the esophagus is involved, it causes esophageal smooth muscle spasm, ischemia, and smooth muscle atrophy and submucosal collagen deposition and fibrosis. The Raynaud phenomenon is often the early manifestation of PSS. The site of telangiectasia seen in PSS is usually the predilection of Raynaud's phenomenon, namely the face, tongue, lips, hands and upper chest. In scleroderma, 95% of patients have Raynaud's phenomenon, 75% of which are caused by Raynaud's phenomenon. These patients often have visceral damage, and the prognosis and final outcome of scleroderma depend largely on the extent of vascular damage. And seriousness.

basic knowledge

The proportion of illness: 0.002%

Susceptible people: no special people

Mode of infection: non-infectious

Complications: esophagitis esophageal stricture

Pathogen

Scleroderma esophagus

(1) Causes of the disease

Scleroderma is a connective tissue disease that affects fibrous tissue and small blood vessels of multiple organs. When the esophagus is involved, it causes esophageal smooth muscle spasm, ischemia, and smooth muscle atrophy and submucosal collagen deposition and fibrosis.

(two) pathogenesis

1. Immunology: This disease often involves autoimmune diseases such as LE, dermatomyositis, rheumatoid arthritis, and various autoantibodies in serum. Although the role of these autoantibodies in the pathogenesis is still unclear, it has been found. Related to the type of disease.

2. Abnormal synthesis of collagen: It is now clear that the tightness and firmness of scleroderma skin is due to the replacement of most or all of the dermis and/or subcutaneous fat by newly synthesized collagen, which makes the skin close to its underlying tissue.

3. Vascular theory: Raynaud's phenomenon is often the early manifestation of PSS. The site of telangiectasia seen in PSS is usually the predilection of Raynaud's phenomenon, namely face, tongue, lip, hand and upper chest. In scleroderma, 95% of patients have Raynaud's phenomenon, 75% of which are caused by Raynaud's phenomenon. These patients often have visceral damage, and the prognosis and final outcome of scleroderma depend largely on the extent of vascular damage. And seriousness.

Prevention

Scleroderma esophagus prevention

There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.

Complication

Scleroderma esophageal complications Complications esophagitis esophageal stricture

Scleroderma esophagus can be complicated by esophagitis and esophageal stricture.

Symptom

Scleroderma esophageal symptoms common symptoms dysphagia lower esophageal sphincter tension decreased bloating heartburn

Esophageal involvement manifests dysphagia, heartburn, vomiting, post-sternal or upper abdomen fullness, due to lower esophageal sphincter closure and decreased esophageal clearance, like achalasia, scleroderma produces slow progressive fluid Difficulty in swallowing with solid food, due to severe gastroesophageal reflux, heartburn symptoms are very significant, scleroderma with typical esophageal involvement in patients with chest radiographs can be seen in the air, esophageal relaxation, lower sphincter can not be closed, barium meal examination further indicates Loss of normal esophageal movement, visible flaccid esophageal and esophageal sphincter opening, or even lack of primary peristalsis, and may also provide evidence of esophagitis or stenosis, esophageal pressure test esophageal and esophageal sphincter showed abnormalities, advanced involvement It can be seen that the esophageal contraction length is reduced, the peristalsis of the smooth muscle of the esophageal body is stopped, and the lower esophageal sphincter tension is very typical in patients with scleroderma esophageal involvement, so that some people define it as "scleroderma esophagus", and radionuclide transfer test detects esophageal movement. And scleroderma esophageal manometry also has Good correlation.

Examine

Scleroderma esophagus examination

Esophageal manometry showed abnormalities in the esophageal body and the lower esophageal sphincter. The length of esophageal contraction was reduced in the advanced stage, and the peristalsis of the smooth muscle of the esophageal body and the decrease of the lower esophageal sphincter were typical in patients with scleroderma and esophageal involvement.

1. Patients with scleroderma and typical esophageal involvement can be seen with air-filled esophageal images on the chest radiograph. The esophagus is slack and the lower sphincter cannot be closed.

2. The barium meal examination further indicates that the normal movement of the esophagus is lost, and the flaccid esophagus and the lower esophageal sphincter are open, and even the primary peristalsis is completely absent, and evidence of esophagitis or stenosis may also be provided.

3. Radionuclide transfer test to detect esophageal movement and scleroderma esophageal manometry also have a good correlation.

Diagnosis

Diagnosis of scleroderma esophagus

Diagnostic criteria

1. First of all, to diagnose scleroderma.

2. The esophagus appears to be delayed in emptying, difficulty in swallowing or reflux symptoms.

3. Esophageal manometry showed a three-low phenomenon.

4.24h esophageal pH monitoring confirmed pathological reflux.

5. Endoscopy confirmed esophagitis, and other esophageal diseases were excluded.

Differential diagnosis

1. Esophageal tuberculosis: Patients with esophageal tuberculosis generally have pioneering symptoms of tuberculosis in other organs, especially tuberculosis. The symptoms of esophagus are often confused or concealed by other organ symptoms, so that they cannot be discovered in time. According to the pathological process of tuberculosis, the stage of early infiltration can be advanced. There are symptoms of fatigue, low fever, increased erythrocyte sedimentation rate, but also symptoms are not obvious, followed by swallowing discomfort and progressive dysphagia, often accompanied by persistent throat and retrosternal pain, aggravation when swallowing, ulcer-type lesions Most of them are characterized by pain when swallowing. Food spilling into the trachea should consider the formation of tracheal esophageal fistula. Difficulty in swallowing suggests that the fibrosis of the lesion causes scarring.

2. Fungal esophagitis: the clinical symptoms of fungal esophagitis are atypical, some patients can have no clinical symptoms, common symptoms are swallowing pain, difficulty swallowing, upper abdominal discomfort, post-sternal pain and burning sensation, severe sternal rear It is like a knife-like colic, which can radiate to the back like angina. Candida esophagitis can cause severe bleeding but is not common. Untreated patients may have epithelial shedding, perforation or even disseminated candidiasis, and esophageal perforation can cause Mediastinal inflammation, esophageal tracheal fistula and esophageal stricture, patients with persistent high fever granulocytopenia should be checked for skin, liver, spleen, lung and other disseminated acute candidiasis.

3. Viral esophagitis HSV infection of the esophagus often has nasal and herpes. The main symptom is swallowing pain. The pain is often aggravated when swallowing food. The food is slow in the esophagus after swallowing. A few patients mainly suffer from dysphagia. Symptoms, mild infection can be asymptomatic.

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