The oesophagus is the part of the GI tract most affected by scleroderma. The jejunum and proximal ileum are also commonly affected . There i...
The oesophagus is the part of the GI tract most affected by scleroderma. The jejunum and proximal ileum are also commonly affected. There is fibrosis of the smooth muscle, resulting in a dilated oesophagus with absent or reduced peristalsis in the lower two-thirds. The upper oesophagus is composed of skeletal muscle and is therefore unaffected. Reflux, Barrett disease and distal strictures are the result.
BARIUM SWALLOW
• Dilated oesophagus.
• Aperistalsis of the distal oesophagus.
• Loss of primary and secondary contractions, tertiary contractions may be seen.
• Lower oesophagus is wide (patulous), in contrast to the tapered narrowing seen in achalasia.
• Gastro-oesophageal reflux.
• Distal stricture (e.g. 5 cm above the GOJ).
• Oesophageal shortening.
BARIUM FOLLOW-THROUGH
• Atrophy of the circular muscle causes stacking of the valvulae—the so-called ‘hide bound’ appearance.
• Sacculations/wide-mouthed diverticulae.
• Delayed transit, reduced peristalsis and pseudo-obstruction.
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