Can psoriatic arthritis affect the esophagus?

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People who have dysphagia may experience symptoms such as:

• difficulty swallowing starchy foods, such as bread or potatoes
• feeling as though food is too big to swallow
• pain in the chest when food travels down the esophagus
• acid reflux after a meal or after eating particular foods
• gastroparesis, where the stomach muscles that push food through the intestines stop working or slow down
• weakness in the esophagus that can cause a pocket to form and trap food
• inflammatory bowel syndrome (IBS) that has links to PsA through triggering chronic inflammation
• ulcerative colitis that relates to PsA and may cause mouth ulcers

Causes

Dysphagia has associations with inflammation in the esophagus.

The causes for this condition may include:

• autoimmune diseases, such as PsA
• allergic reactions
• head and neck cancers
• gastroesophageal reflux disease (GERD)
• foreign bodies or food lodged in the throat
• throat infection
• peptic ulcer disease
• some medications for PsA, including methotrexate, adalimumab, infliximab, and leflunomide, may cause difficulty swallowing as a side effect
• Sjögren’s disease
• stroke or head injury

Some noninflammatory responses could also include changes related to older age, severe respiratory issues, and neurological conditions such as Alzheimer’s disease and Parkinson’s disease.

Treatment

Generally, the treatment that doctors recommend depends on the underlying cause of dysphagia. If a person is unable to swallow medication, they should speak with a healthcare professional.

Treatments for dysphagia may include:

• changing a person’s diet
• dilation of the esophagus by using a device to expand narrow areas of the esophagus
• surgery to remove any blockage
• endoscopy, which involves using a long thin scope to remove a stuck object
• antibiotics to treat an esophagus infection
• medication changes to reduce side effects

Treatments for PsA and esophagus issues may include exercises to help a person swallow more effectively.

GERD, also known as acid reflux, occurs when the upper part of the digestive tract is not working correctly. Heartburn is a common symptom of this condition, where a person experiences a burning pain behind the breastbone that begins in the chest and moves upward.

Eating certain types of food or lying down 2–3 hours after a meal can worsen symptoms. The contents of the stomach may flow back into the esophagus, causing the sensation of food to come back up into the throat or mouth with an accompanying acidic taste.

Less common symptoms of GERD include:

• a persistent sore throat or hoarseness
• chronic cough
• asthma
• difficult or painful swallowing
• bad breath
• unexplained chest pain
• a lump in the throat sensation
• feeling uncomfortably full after a meal

Complications of GERD may include:

• appetite loss
• Barrett’s esophagus, where the lining of the esophagus changes
• pain in the chest
• problems or pain while swallowing
• vomiting regularly or vomit that may contain blood or look similar to coffee grounds
• stools with blood or that look tarry and black
• unexplained weight loss

A person with these symptoms should consult with a healthcare professional.

Causes

There is no research examining a link between PsA and GERD. Additionally, there is no single known cause of GERD — researchers attribute GERD to damage to the esophagus or weakness in part of the GI system. Medications for PsA may also lead to GERD as a side effect.

Treatment

The goals of treating GERD are to bring the condition under control, heal the esophagus, and manage or prevent complications such as Barrett’s esophagus. Doctors also aim to keep symptoms to a minimum so a person can lead a reasonably normal life.

Doctors are likely to treat GERD separately from PsA.

Treatments for GERD may involve:

• avoiding acidic foods and drinks
• over-the-counter medication to reduce stomach acid
• H2 blockers to reduce stomach acid
• proton pump inhibitors to reduce stomach acid
• quitting smoking
• maintaining a moderate weight
• surgery if medication is not working

While GERD can cause chest pain, a person experiencing this symptom should speak with a healthcare professional to rule out heart issues.

Chest pain is also a symptom of eosinophilic esophagitis. This condition may cause difficulty swallowing, chest or upper abdomen pain, or food impactions, where food becomes stuck in the esophagus.

Eosinophilic esophagitis is a condition that affects the digestive system. The National Organization for Rare Disorders notes that there is a large number of white blood cells, called eosinophils, present with this condition.

These cells are a part of a person’s immune system and fight infections. Therefore, large numbers of these cells indicate an allergic condition.

An individual may develop eosinophilic esophagitis due to hypersensitive responses to food and environmental triggers.

It also has links to autoimmune conditions, including lupus, rheumatoid arthritis, and PsA. Both children and adults can experience eosinophilic esophagitis.

A healthcare professional usually diagnoses functional chest pain when they rule out other possible reasons, including:

• heart conditions
• GERD
• lungs conditions
• muscular issues
• liver or pancreas issues
• neurological or mental health conditions

Treatment

Treatment of functional chest pain aims to reduce symptoms and improve quality of life. Doctors typically provide people with this symptom with neuromodulators or antidepressants to help with the pain. They may also recommend talking therapies.

People with PsA may also experience mental health conditions, so an individual with functional chest pain and PsA may find therapies for mental health conditions beneficial.

Some esophageal conditions are due to atypical motility. Motility is the ability of the esophagus to move food into the stomach.

Hypersensitivity in the esophagus’s nerves, muscles, and receptors may cause esophageal symptoms, including chest pain. Some esophageal-related conditions may include:

• Jackhammer esophagus: The esophageal muscle has atypical, intense, and long-lasting contractions.
• Distal esophageal spasm: Muscle spasms in the lower part of the esophagus may cause regurgitation of food.
• Achalasia: Failure of the lower part of the esophagus to push food into the stomach may cause food regurgitation. Here, food may move into the lungs and cause breathing difficulties.
• Sjögren’s disease: Causes dryness in the body, including the mouth, which can cause dysphagia. This disease has an autoimmune connection, which links it to PsA.
• Autoimmune conditions: People with one autoimmune condition, including PsA, may be more likely to develop others.

The inability to eat and swallow food easily could cause unexplained weight loss, regular regurgitation, or vomiting. Food may also feel as though it is obstructing the chest or throat, which can cause breathing difficulties.

A person should seek immediate help from a healthcare professional if they experience breathing problems.

There is no direct link between PsA and esophageal conditions, but autoimmune conditions can contribute to both. However, there is an association between PsA and IBS or ulcerative colitis.

A person noticing frequent symptoms of GERD, esophageal issues, or unexplained chest pain should consult with a healthcare professional.