OESOPHAGEAL INVOL VEMENT IN SYSTEMIC DISEASE

OESOPHAGEAL INVOL VEMENT IN SYSTEMIC DISEASE

The oesophagus can be a ff ected by a variety of systemic diseases; examples include systemic sclerosis/scleroderma, polymyositis, dermatomyositis, systemic lupus erythematosus and polyarteritis nodosa. Scleroderma most frequently The oesophagus is the most commonly a ff ected part of the gastrointestinal tract, characterised by the excessive deposit of collagen, resulting in fibrosis. Symptoms are related to GORD (heartb ur n and regurgitation) as well as dysmotility (dysphagia and chest discomfort). On HRM the classical findings are poor oesophageal motility or even distal oesophageal aperistalsis (smooth muscle portion), with a hypotensive LOS. GORD can be severe because of the combination of dysmotility and hypotensive LOS, and complications such as peptic strictures and Barrett’s oesophagus can be found in about one-third of patients. Management is directed at the control of GORD. PPIs remains the mainstay of treatment but standard doses may not be enough. Other medicines such as prokinetics and alginic acid may be added, though e ffi cacy is limited. The results of surgical fundoplication are suboptimal because of poor oesophageal motility . Strictures are treated by standard endoscopic therapy .

(a) Figure 66.40 Inlet patch or heterotopic gastric mucosa in the upper oesophagus. (b ) Using narrow-band imaging.