In patients with swallowing problems, a relatively broad approach to the differential diagnosis is required, incorporating a complete review of systems.
Connective tissue disorders commonly manifest with dysphagia. The characterization of esophageal function may help with diagnosis or classification of these disorders.
Esophageal motility disorders associated with connective tissue disease are usually hypocontractile disorders.
Abnormal upper intestinal motility is common in diabetics. The association of these findings with symptoms is not straightforward. Gastroesophageal reflux disease is probably more common in diabetics for many reasons.
Chagas' disease is rare in the United States. Physicians should be aware of its cardinal findings: cardiomyopathy, megacolon, and achalasia-like esophageal motility disorder.
The diagnosis of paraneoplastic esophageal motility disorders requires a heightened suspicion in current or former smokers with severe dysphagia or intestinal motility of relatively short duration. Specific tests focusing on serum antibodies and chest imaging are usually required for diagnosis.
Esophageal inflammation resulting from systemic disease is usually the result of a few specific disorders: sarcoidosis, amyloidosis, and other rare skin disorders.
Systemic Sclerosis and Gastroesophageal Reflux Disease
Studies on the pathogenesis of gastroesophageal reflux disease (GERD) in SSc suggest that decreased esophageal clearance is a central pathophysiologic factor its development. One study demonstrated higher degrees of acid in the esophagus, both distal and proximal, in those with aperistalsis compared to those with intact peristalsis. Lower esophageal sphincter pressure was not significantly different between the two groups.
Delayed gastric emptying can be a prominent feature in many of those with SSc. However, to date it has been difficult to implicate delayed gastric emptying as a cause of GERD or reflux symptoms. One investigator demonstrated a correlation between delayed gastric emptying and symptoms of reflux and dysphagia.15 Others have demonstrated some improvement in the upper gastrointestinal (GI) tract, but not specifically reflux symptoms with improved gastric emptying. No association has been determined between delayed gastric emptying and esophageal clearance.
Key Points
In patients with swallowing problems, a relatively broad approach to the differential diagnosis is required, incorporating a complete review of systems.
Connective tissue disorders commonly manifest with dysphagia. The characterization of esophageal function may help with diagnosis or classification of these disorders.
Esophageal motility disorders associated with connective tissue disease are usually hypocontractile disorders.
Abnormal upper intestinal motility is common in diabetics. The association of these findings with symptoms is not straightforward. Gastroesophageal reflux disease is probably more common in diabetics for many reasons.
Chagas' disease is rare in the United States. Physicians should be aware of its cardinal findings: cardiomyopathy, megacolon, and achalasia-like esophageal motility disorder.
The diagnosis of paraneoplastic esophageal motility disorders requires a heightened suspicion in current or former smokers with severe dysphagia or intestinal motility of relatively short duration. Specific tests focusing on serum antibodies and chest imaging are usually required for diagnosis.
Esophageal inflammation resulting from systemic disease is usually the result of a few specific disorders: sarcoidosis, amyloidosis, and other rare skin disorders.
Systemic Sclerosis and Gastroesophageal Reflux Disease
Studies on the pathogenesis of gastroesophageal reflux disease (GERD) in SSc suggest that decreased esophageal clearance is a central pathophysiologic factor its development. One study demonstrated higher degrees of acid in the esophagus, both distal and proximal, in those with aperistalsis compared to those with intact peristalsis. Lower esophageal sphincter pressure was not significantly different between the two groups.
Delayed gastric emptying can be a prominent feature in many of those with SSc. However, to date it has been difficult to implicate delayed gastric emptying as a cause of GERD or reflux symptoms. One investigator demonstrated a correlation between delayed gastric emptying and symptoms of reflux and dysphagia.15 Others have demonstrated some improvement in the upper gastrointestinal (GI) tract, but not specifically reflux symptoms with improved gastric emptying. No association has been determined between delayed gastric emptying and esophageal clearance.
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