Twenty patients with scleroderma of the esophagus were treated with esophageal dilation, an anti-reflux procedure, or colon interposition over a 12-year period. Antireflux procedures consisted of the following: six Belsey Mark IV, two Collis-Belsey, three Nissen, and one Collis-Nissen. Reflux esophagitis recurred in all patients at an average of 4 years postoperatively. Esophageal strictures were severe in 3 patients and necessitated partial esophagectomy and short-segment colon interposition. These patients had been on a regimen of long-standing high-dose steroid therapy, and none showed any wound healing problems or postoperative leaks. There was 1 death, which occurred fifteen days postoperatively as a result of pulmonary complications. Control of reflux and dysphagia can be achieved with antireflux procedures, but in our experience, all will ultimately fail in time. We believe esophageal replacement should be considered as the initial step in treatment of strictures of the esophagus in patients with scleroderma.