Title: Scleroderma - UCLA Robert G. Kardashian Center for Esophageal Health - Los Angeles, CA
Headings: 
What is scleroderma?
What causes scleroderma?
What are the symptoms of scleroderma?
How is scleroderma diagnosed?
How is scleroderma treated?

Content: There is a ring of muscle positioned at the junction of the esophagus and stomach (the esophagogastric junction or EGJ) called the lower esophageal sphincter (LES). When swallowing is not occurring it is contracted, closing the EGJ and producing a barrier to the reflux of injurious gastric contents back into the esophagus. Scleroderma patients often have a weak or incompetent LES, which predisposes them to gastroesophageal reflux disease (GERD). Pathological acid reflux frequently produces symptoms of heartburn (a burning sensation in the chest) and/or regurgitation (the unforced return of stomach or esophageal contents to the mouth or throat). Left untreated, GERD can cause esophagitis, esophageal ulceration, esophageal strictures or Barrett's esophagus, which can be a precursor to esophageal cancer. Gastroparesis associated with scleroderma makes GERD worse because the stomach remains filled with noxious materials for a longer time after eating. This prolongs the time over which gastroesophageal reflux can occur. The combination of GERD and gastroparesis can predispose patients to aspiration of gastric contents into the airway, which can be manifest as cough, pneumonia and/or worsening lung function. Normally, swallowing produces a ring of esophageal contraction called peristalsis, which sweeps swallowed materials down the esophagus and into the stomach. Patients with scleroderma of the esophagus typically lack this peristaltic contraction, which is called aperistalsis.