Impaired Swallowing Linked to Depression, Lower Quality of Life in Scleroderma, Study Finds

Swallowing trouble in people with scleroderma is associated with lower quality of life and a higher incidence of depression, a study found.

The study, “Oropharyngeal swallowing functions are impaired in patients with scleroderma,” was published in the journal Clinical and Experimental Rheumatology.

Swallowing involves both voluntary and reflexive actions, and is divided into three phases: oral, in which food is chewed and mixed with saliva in the mouth to form a bolus, which the tongue moves toward the back of the mouth; pharyngeal, in which breathing is momentarily stopped to keep food and liquids from entering the airway; and esophageal, when the bolus moves into the esophagus and then to the stomach.

Evidence indicates that 87% of patients with progressive scleroderma have difficulty swallowing (dysphagia).

A video-based study showed that the windpipe (trachea) may not be properly closed in people with scleroderma. This can result in food or liquid moving into the lungs (aspiration), which can cause difficulty breathing, cough, or aspiration pneumonia.

No previous study had focused on the pharyngeal phase of swallowing in scleroderma patients. Investigators at Ege University School of Medicine in Turkey set out to do that, while at the same time analyzing symptoms of depression.

While previous research suggested the oral and esophageal phases of swallowing were the culprits for dysphagia in scleroderma, the study showed that the pharyngeal phase is also involved, the researchers said.

“The pharyngeal phase disorders can be treated by different physical exercises and rehabilitation methods, thus showing its clinical importance,” they said.

A total of 28 people (mean age 48.4 years) with systemic sclerosis and 40 healthy controls underwent a fiberoptic evaluation of swallowing. This test assesses swallowing by passing a flexible tube called an endoscope through the nose and into the pharynx. The endoscope, equipped with a tiny camera and light, enables physicians to evaluate in real time how well a patient swallows saliva and foods of different textures and sizes.

After swallowing fish-shaped crackers, 28.6% of the patients had residue in the beginning of their upper airways — more specifically, in the vallecula, retrocricoid area, pharyngeal wall or piriform sinuses — compared with 15% in the control group.

The formation of residue during swallowing increases the risk for aspiration pneumonia and further complications, the scientists said.

Participants also answered a dysphagia-specific questionnaire on quality of life. The scleroderma group reported a lower quality of life due to dysphagia relative to the control group.

Scleroderma patients also showed a higher incidence of depression than controls, as measured by the Beck Depression Inventory (mean score of 15.07, compared with 8.03)

“Swallowing dysfunction and its association with lower quality of life and higher incidence of depression in patients with scleroderma has been shown by objective findings for the first time,” the researchers said.