Decreased tone of the lower esophageal sphincter is one of the symptoms of scleroderma esophagus. sclerodermal esophagus refers to scleroderma, also known as progressive systemic sclerosis, which involves the esophageal muscle layer to develop its kinetic abnormalities. Esophageal involvement manifests with dysphagia, heartburn, mostly accompanied by vomiting and a feeling of fullness behind the sternum or in the upper abdomen. Scleroderma produces slowly progressive difficulty in swallowing liquid and solid foods due to closure of the lower esophageal sphincter and impaired esophageal clearance like in cardia incontinentia. Heartburn symptoms are significant due to severe gastroesophageal reflux . A barium meal further demonstrates the loss of normal esophageal motility, with flaccid esophagus and lower esophageal sphincter opening, or even a complete lack of primary peristalsis, and may also provide evidence of esophagitis or stricture. Esophageal manometry examination of the esophageal body and lower esophageal sphincter shows abnormalities. Progressive involvement is seen as a decrease in esophageal contraction length. Partial peristaltic arrest of the smooth muscle of the esophageal body and decreased tone of the lower esophageal sphincter are so typical in patients with scleroderma esophageal involvement that it has been defined as a “scleroderma esophagus” radionuclide transfer test, and there is a good correlation between the detection of esophageal motility and scleroderma esophageal manometry: The natural course of decreased tone of the lower esophageal sphincter varies widely. The natural course of reduced lower esophageal sphincter tone varies widely, with a 10-year survival rate of 65% after the first diagnosis. It is usually chronic and progressive, but may resolve on its own. The course of the disease often alternates between remission and exacerbation. The clinical course is faster in men than in women, and male patients tend to have a poorer prognosis. The prognosis is poor in those with renal, cardiac, and pulmonary involvement. Some patients die from renal failure, heart failure, pulmonary infections, nutritional disorders, and intestinal necrosis. The disease may resolve to a quiescent state during pregnancy and then progress again after delivery.