Upper dysphagia in patients affected by systemic sclerosis: prevalence and features

Herein, we describe the prevalence and features of dysphagia in patients affected by systemic sclerosis (SS). We analysed the data of 19 patients obtained by administering the M.D. Anderson Dysphagia Inventory (MDADI) scale that measures dysphagia symptoms and by physical assessment consisting of judging specific lip, mandible and tongue performances (scale 0-3) and diadochokinesis, respiratory and phonatory functions (scale “poor”, “fair”, “good”, “normal”) according to Robertson’s method. Subjects also underwent flexible endoscopic examination of swallowing. MDADI showed that 74% of answers were included in “mild” class of disability, 21% as “moderate” and 5% as “severe”. The performance of lips, mandible and tongue that most frequently scored 1 were the opening (52.6% for the lips and 47.4% for the mandible) and the pop of the tongue (52.7%). The percentage of compromised respiratory, phonatory and diadochokinesis tests (“poor” or “fair”) was 81%, 70.1% and 74%, respectively. Flexible endoscopic examination of swallowing revealed pharyngolaryngeal sensory deficit and signs of oropharyngeal dysphagia in more than half of cases (58% and 53%, respectively). This study highlights the presence of dysphagia in SS patients and demonstrates the importance of a multidimensional approach that includes subjective and objective evaluation to characterise specific features of swallowing alterations that have a high-impact on upper dysphagia.