The esophagus is a multilayered organ that can be affected in several rheumatologic conditions. The impaired function of the esophagus can significantly impact the quality of life of patients with these chronic conditions. The understanding of normal esophageal anatomy and physiology, and pathophysiologic mechanisms is crucial to identify the mechanisms that lead to the onset of esophageal manifestations. Systemic lupus erythematosus (SLE), sarcoidosis, rheumatoid arthritis (RA), and scleroderma are common rheumatologic diseases that can lead to esophageal dysmotility, reflux, alteration in composition, among others. Associated complications such as aspiration, stricture formation and esophageal metaplasia may occur. The understanding of presenting symptoms, available imaging modalities for diagnosis and monitoring, appropriate pharmacologic therapy, and indications for endoscopic or surgical intervention is paramount to prevent disease progression.