A Frustrating Daily Battle
Imagine taking a strong pill every day for heartburn, yet the burning pain keeps coming back. For many people with a condition called systemic sclerosis (scleroderma), this is a daily reality. The standard medicine—proton pump inhibitors (PPIs)—often doesn’t work for them.
A new study looked at why these pills fail and found the answer lies in how the muscles in the esophagus and stomach move. It’s not just about acid; it’s about how food and liquid travel through the digestive system.
Systemic sclerosis, or scleroderma, is a disease where the immune system attacks the body’s tissues, causing the skin and internal organs to become stiff and scarred. It affects about 1 in 10,000 people, mostly women.
One of the most common problems is gastroesophageal reflux disease (GERD), where stomach acid flows back into the esophagus. This causes heartburn, chest pain, and can even damage the lungs over time.
Doctors usually prescribe PPIs to lower acid levels. But in scleroderma, many patients still have symptoms. This study set out to find out why.
The Old Way vs. The New Way
For years, doctors assumed that if heartburn pills didn’t work, the problem was just “bad acid.” So they’d increase the dose or switch medications.
But here’s the twist: This study shows the issue is often mechanical. The muscles that move food from the throat to the stomach are weak or don’t work at all. This means even with less acid, the backflow still happens because the system can’t clear it properly.
How It Works: A Traffic Jam Analogy
Think of your esophagus as a highway. Normally, muscles contract in a wave to push food down to the stomach—like cars moving smoothly in traffic.
In scleroderma, these muscles can be damaged. The highway gets clogged. Food and acid sit longer, causing backups and spills.
The study also found problems in the stomach. If the stomach doesn’t empty well, it’s like a parking lot that’s too full. This increases pressure and pushes more contents back up into the esophagus.
Researchers at one hospital reviewed 30 adults with scleroderma who were taking twice-daily PPIs between 2021 and 2025. All patients had special tests to measure reflux and muscle movement in the esophagus and stomach.
They used pH-impedance monitoring to track acid and non-acid reflux, high-resolution manometry to check esophageal muscle contractions, and gastric emptying scans to see how fast the stomach emptied.
The results were striking. Nearly all patients—97%—had reflux that didn’t respond to PPIs. Most had clear evidence of reflux, and many had borderline cases that were still problematic.
Esophageal muscle problems were found in 80% of patients. The most common issue was “absent contractility,” meaning the muscles didn’t contract at all to push food down. This led to poor clearance of acid from the esophagus. On average, acid stayed in the esophagus twice as long in these patients compared to those with normal muscle function.
Reflux episodes also lasted much longer—over 16 minutes on average versus less than 2 minutes in those with normal muscles.
Stomach muscle problems were found in 61% of patients. These patients had more frequent reflux episodes—about 51 per day compared to 25 in those with normal stomach emptying.
But There’s a Catch
This study is small and only looked at patients from one hospital. It doesn’t prove that fixing muscle problems will solve reflux in all scleroderma patients. More research is needed to confirm these findings.
The researchers say this study highlights the need for a more complete evaluation in scleroderma patients with stubborn reflux. Instead of just increasing acid suppression, doctors should test for muscle problems in the esophagus and stomach. This could help tailor treatments to the specific cause.
If you have scleroderma and heartburn that won’t go away, talk to your doctor about tests for esophageal and stomach muscle function. These tests are available now, but not all doctors may be familiar with them. Understanding the root cause could lead to better treatment options beyond just acid pills.
This doesn’t mean this treatment is available yet.
The study was small, with only 30 patients, and was retrospective, meaning it looked back at past data. It was also done at a single center, so the results may not apply to everyone. More research is needed to see if these findings hold up in larger groups.
Next steps include larger studies to confirm these results and trials to test treatments that target muscle problems, such as drugs that improve stomach emptying or procedures to strengthen the esophagus. Until then, doctors can use these findings to better evaluate and manage reflux in scleroderma patients.
