In scleroderma, how is esophageal function typically affected?

• A. Esophageal hypomotility with reduced peristalsis and decreased LES tone leading to GERD.
• B. Esophageal hypermotility with increased peristalsis and increased LES tone.
• C. Normal motility with normal LES tone.
• D. Esophageal spasm without reflux.

Answer: (A)

In scleroderma, the smooth muscle of the distal esophagus becomes fibrotic, leading to weak contractions and poor peristalsis. At the same time, the lower esophageal sphincter tends to be hypotensive. This combination means the esophagus doesn’t move food down effectively and the barrier to reflux is weakened, so gastric contents reflux into the esophagus more easily, causing GERD. The pattern described—reduced peristalsis with a decreased LES tone—is the typical esophageal change in this condition. The other options don’t fit because they imply either increased or normal motility or lack the reflux-prone pattern seen with scleroderma.