Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder where the immune system mistakenly attacks healthy tissues. The condition can involve nearly any organ system, including the gastrointestinal tract. Dysphagia, defined as difficulty or discomfort in swallowing, is a symptom that can arise in SLE patients. Up to 13% of individuals with SLE may experience dysphagia, confirming a direct link between the disease and swallowing problems. This difficulty stems from the systemic inflammation affecting the muscular and nervous components required for a smooth swallow.
Systemic Lupus and the Swallowing Mechanism
The process of swallowing involves the coordinated action of muscles in the throat and the esophagus. Lupus disrupts this coordination by causing inflammation in these tissues, similar to myositis. This inflammatory activity weakens the muscles responsible for moving food to the stomach. The smooth muscle in the lower two-thirds of the esophagus is particularly susceptible to lupus-related inflammation.
Muscle involvement leads to esophageal dysmotility, where the normal, rhythmic contractions (peristalsis) become weak or cease entirely. Manometry studies show that up to 72% of SLE patients exhibit abnormal esophageal muscle function. This manifests as aperistalsis (absence of propulsive waves) or hypoperistalsis (ineffective, weak movement).
Lupus activity also affects the nerves that regulate swallowing. Vasculitis, or inflammation of small blood vessels, can occur around nerves in the gastrointestinal tract. This leads to ischemic damage to the Auerbach plexus, the nerve network in the esophageal wall controlling muscle contraction. Damage to this network results in discoordination, disrupting the precise timing required for swallowing.
SLE can cause a weakened lower esophageal sphincter, the muscular ring between the esophagus and the stomach. This weakness allows stomach acid to flow backward, resulting in Gastroesophageal Reflux Disease (GERD). Chronic acid reflux, which affects up to half of SLE patients, irritates and scars the esophageal lining, further contributing to dysphagia.
Recognizing Signs of Swallowing Difficulty
Swallowing problems begin with the sensation that food is not passing cleanly through the throat or chest. This feeling of material “getting stuck” is a common initial sign, particularly with solid or dry foods. Difficulty may progress to pain when swallowing, medically termed odynophagia.
A person with lupus-related dysphagia may cough, choke, or gag during or after a meal. This reaction signals that food or liquid is entering the airway, often noticeable when swallowing thin liquids. Other symptoms include the regurgitation of undigested food or excessive drooling due to difficulty managing saliva.
Impaired swallowing can lead to avoidance of certain foods and liquids, resulting in prolonged mealtimes. Unintended weight loss, poor nutritional intake, and dehydration signal that the swallowing issue is becoming severe. Recognizing these changes is important for seeking medical help.
Medical Evaluation and Management Strategies
Evaluation for lupus-related dysphagia begins with assessment to pinpoint the problem and rule out other causes. A common initial test is the barium swallow study (videofluoroscopic examination), which uses X-ray video to visualize substance movement through the pharynx and esophagus. This imaging identifies where the food bolus is stalling and whether aspiration into the airway is occurring.
If muscle dysfunction is suspected, the specialist may perform an esophageal manometry test. This procedure involves passing a thin tube with pressure sensors into the esophagus to measure the strength and coordination of muscle contractions. An upper endoscopy (EGD) visually inspects the lining of the esophagus and stomach, checking for ulcers, inflammation, or infections like candidiasis.
The management strategy for dysphagia in SLE addresses both the underlying autoimmune disease and the physical swallowing impairment. Since dysphagia is often a manifestation of active lupus inflammation, treatment involves increasing the dose of immunosuppressive medications, such as corticosteroids. Successfully controlling the lupus activity can lead to an improvement in swallowing symptoms.
A referral to a speech-language pathologist (SLP) is typically recommended. The SLP provides targeted swallowing therapy, including exercises to strengthen pharyngeal muscles and improve oral motor control. Dietary modifications, such as thickening liquids and pureeing solid foods, are used to reduce the risk of aspiration. Patients are also taught compensatory postural techniques, like the chin-tuck maneuver, to protect the airway during meals.