Decreased tone of the lower esophageal sphincter is one of the symptoms of scleroderma esophagus, then with decreased tone of the lower esophageal sphincter, the following tests need to be done: Esophageal involvement manifests with dysphagia, heartburn, mostly accompanied by vomiting and a feeling of fullness behind the sternum or upper abdomen. Due to closure of the lower esophageal sphincter, esophageal clearance is diminished like in cardia incontinentia and scleroderma produces slowly progressive difficulty in swallowing liquid and solid foods. 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 detection of esophageal motility and scleroderma esophageal manometry: 1. 3. esophageal manometry shows three lows; 4. 24h esophageal pH monitoring confirms pathological reflux; 5. endoscopic evidence of esophagitis and other esophageal diseases are excluded.