Swallowing when you have Scleroderma

Living with scleroderma, or systemic sclerosis, means dealing with unexpected challenges that can impact your daily life. One of the less-talked-about areas is how scleroderma affects the mouth and esophagus, leading swallowing problems. While these symptoms might seem minor, they can have a significant impact on your quality of life and overall health. Let’s dive into what’s happening and how to manage it.

What is Scleroderma?

Scleroderma is an autoimmune disease that can affect many parts of the body, including the skin, joints, lungs, and even the digestive system. But unlike other autoimmune conditions that cause inflammation, scleroderma’s symptoms often result from fibrosis. Fibrosis means the buildup of scar tissue, which can cause the skin and tissues to harden.

There are two main types: Limited Systemic Sclerosis, often referred to as CREST Syndrome, and Diffuse Systemic Sclerosis. Both forms can affect the mouth and esophagus, making it difficult to maintain good dental health and swallow food comfortably.

Scleroderma and Dry Mouth

When it comes to the mouth, scleroderma can create a unique set of challenges. Just like it can tighten the skin on your hands or face, scleroderma can also tighten the skin around your mouth. This can make it harder to open your mouth fully, leading to discomfort and even problems with oral hygiene. On top of everything—scleroderma is often accompanied by secondary Sjogren’s syndrome, another autoimmune condition that reduces saliva production.

Saliva does more than just keep your mouth moist. It’s a natural defense mechanism that helps wash away bacteria, prevents tooth decay, and aids in swallowing. Without enough saliva, you’re at higher risk for tooth decay and gum disease. It can also make swallowing more challenging, as food might feel like it’s sticking in your throat.

So, how can you manage dry mouth with scleroderma? Here are some strategies:

• Stay Hydrated: Drinking water throughout the day can help keep your mouth moist.
• Chew Sugar-Free Gum: Chewing gum stimulates saliva production, which can ease dryness.
• Specialized Toothpaste & Toothbrushes: Opt for products designed for sensitive mouths. A toothbrush with a smaller head or longer handle might make brushing easier, especially if the skin around your mouth is tight.
• Regular Dental Visits: It’s essential to see a dentist regularly and inform them about your scleroderma diagnosis. This helps them tailor their approach to your care, using smaller instruments or scheduling longer appointments.
• Medications: If dryness persists, talk to your doctor about prescription medications like pilocarpine, which can help stimulate saliva production.

Scleroderma and Swallowing Problems

Now, let’s talk about the esophagus. The esophagus is the muscular tube that connects your mouth to your stomach, helping to move food down. In scleroderma, fibrosis can affect the smooth muscles in the lower half of the esophagus. As the muscles thicken and harden, they lose their ability to contract properly. This means food might not move down smoothly, causing a sensation of food getting stuck in the throat or chest.

Another issue is the lower esophageal sphincter (LES), which is the valve that keeps stomach acid from flowing back up. Scleroderma can weaken this valve, allowing acid to escape into the esophagus. This can cause symptoms like heartburn, chest pain, a sour taste in the mouth, or frequent burping. If left untreated, acid reflux can irritate the lining of the esophagus, causing narrowing or strictures, making swallowing even harder.

Here’s how to manage swallowing problems and reflux with scleroderma:

• Eat Smaller, Frequent Meals: Large meals put more pressure on the esophagus, so opt for smaller, more frequent meals to make swallowing easier.
• Drink Water with Meals: Sipping water as you eat can help move food down more smoothly.
• Elevate Your Head While Sleeping: Sleeping with your head elevated helps keep stomach acid in your stomach, reducing nighttime reflux.
• Medications: Ask your doctor if acid-reducing medications like proton pump inhibitors (PPIs) or H2 blockers are needed. Sometimes, a combination of these medications is necessary to control reflux.
• See a Specialist: If you’re still struggling despite these adjustments, it might be time to see a gastroenterologist. They can perform tests to check for narrowing or blockages in the esophagus and, if needed, perform esophageal dilation to help widen it.

When to Talk to Your Doctor

If you’re dealing with persistent dry mouth or swallowing issues, it’s crucial to communicate openly with your healthcare team. Let them know about any new symptoms or changes, and don’t hesitate to ask for a referral to a specialist. Good communication is key to managing scleroderma effectively.

Remember, you’re not alone on this journey—talk to your doctor and make sure you’re getting the support you need.