Gazi Sağlık Bilimleri Dergisi

Öz

Scleroderma is a rare autoimmune disease characterized by changes in humoral and cellular immunity, causing fibroproliferative changes in microvascularity and as a result, abnormal collagen deposition in the skin and internal organs. Swallowing is a complex function that ensures the delivery of substance from the mouth and saliva to the stomach. Dysphagia is associated with impaired swallowing function and can be defined as difficulty and failure in transporting food or liquids to the stomach. It has been reported that 87% of patients with progressive systemic sclerosis complain of dysphagia. In fact, approximately 60% of these patients definitely mentioned swallowing difficulties in their first examination. It is known that dysphagia affects these patients in varying degrees, including aspiration, pneumonia, malnutrition, increased mortality, decreased immunity, prolonged hospitalization, severe disability, decreased quality of life, and isolation from the community. There are four phases of swallowing: oral preparation, oral, pharyngeal, and esophageal. Disturbance in any phase of swallowing can be seen in scleroderma. The most common symptoms of dysphagia in scleroderma patients are; Decreased mouth opening caused by limitation of the mouth and surrounding skin and temporamandibular joint, loss of saliva, atrophy in the tongue muscles, feeling of food left in the throat, coughing during swallowing, food or liquid coming back into the throat, food leakage from the mouth. Since the symptoms of dysphagia in these patients vary widely, the treatment plan should be tailored for each patient. It is very important to determine which phase of swallowing is affected in these patients in terms of deciding on the treatment of dysphagia. It should not be forgotten that a multidisciplinary approach is required for swallowing rehabilitation to be effective. In addition to the swallowing therapist, many professions such as occupational therapist, rheumatologist, dentist and physiotherapist should work at the same time for symptoms such as difficulty in preparing meals, inability to use the hands adequately, decreased mouth opening, saliva and chewing insufficiency seen in oral preparation and oral phase. One of the most important symptoms in swallowing in scleroderma is coughing while drinking liquids. Since cough can be an indicator of aspiration, it should be considered as a symptom that should not be forgotten when evaluating the patient. Medical therapy, surgical procedures, and swallowing therapy should be considered as options in the dysphagia treatment plan. Since scleroderma is a chronic disease, it should not be forgotten that close follow-up of the treatment processes is very important.