Management for oesophageal dysmotility and gastro-oesophageal reflux in systemic sclerosis

Oesophageal dysmotility, with symptoms of gastro-oesophageal reflux (GORD), occurs in all patients with systemic sclerosis. If associated with pulmonary aspiration, it may worsen outcomes of systemic sclerosis–associated interstitial lung disease.

Management for oesophageal dysmotility and GORD is best undertaken in consultation with a gastroenterologist. Proton pump inhibitors (PPIs) are the mainstay of drug treatment for GORD and high doses may be requiredKowal-Bielecka, 2017; see Management of frequent or severe symptoms of GORD in adults.

There are no effective prokinetic drugs for oesophageal dysmotility. Nonpharmacological measures include elevating the head of the bed, eating soft food and small meals, and drinking liquids with meals. Advise patients to avoid tobacco smoking, alcohol and the use of opioids.

Some patients develop oesophageal strictures and may require repeated endoscopic dilations.