Albany Medical College, Albany, NY 12208, United States.
Department of Dentistry, Ministry of Health, Alexandria 21500, Egypt.
World J Gastroenterol. 2021 Aug 21;27(31):5201-5218. doi: 10.3748/wjg.v27.i31.5201.
Systemic sclerosis is a connective tissue disease that presents with significant gastrointestinal involvement, commonly in the esophagus. Dysphagia is a common clinical manifestation of systemic sclerosis and is strongly related to esophageal dysmotility. However, there are multiple other contributing factors in each step in the physiology of swallowing that may contribute to development of severe dysphagia. The oral phase of swallowing may be disrupted by poor mastication due to microstomia and poor dentition, as well as by xerostomia. In the pharyngeal phase of swallowing, pharyngeal muscle weakness due to concurrent myositis or cricopharyngeal muscle tightening due to acid reflux can cause disturbance. The esophageal phase of swallowing is most commonly disturbed by decreased peristalsis and esophageal dysmotility. However, it can also be affected by obstruction from chronic reflux changes, pill-induced esophagitis, or Candida esophagitis. Other contributing factors to dysphagia include difficulties in food preparation and gastroparesis. Understanding the anatomy and physiology of swallowing and evaluating systemic sclerosis patients presenting with dysphagia for disturbances in each step can allow for development of better treatment plans to improve dysphagia and overall quality of life.
系统性硬化症是一种结缔组织疾病，常伴有明显的胃肠道受累，常见于食管。吞咽困难是系统性硬化症的常见临床表现，与食管动力障碍密切相关。然而，在吞咽生理的每一个步骤中，还有许多其他的影响因素可能导致严重的吞咽困难。在吞咽的口腔阶段，由于小口畸形和牙齿不良导致咀嚼不良，以及口干，可能会导致吞咽中断。在吞咽的咽阶段，由于同时存在肌炎导致的咽肌无力，或由于胃酸反流导致的环咽肌收紧，可能会引起紊乱。吞咽的食管阶段最常因蠕动减少和食管动力障碍而受到干扰。然而，它也可能受到慢性反流变化、药物引起的食管炎或念珠菌性食管炎引起的阻塞的影响。吞咽困难的其他影响因素包括食物准备困难和胃轻瘫。了解吞咽的解剖和生理学，并评估出现吞咽困难的系统性硬化症患者在每个阶段的紊乱情况，可以制定更好的治疗计划来改善吞咽困难和整体生活质量。
