Scleroderma Gastrointestinal Involvement

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Biomarkers for Scleroderma GI
Correlation with Other Symptoms
Digestive Involvement
Bowel Dysfunction
Dysmotility Syndrome
Dysphagia (Difficulty Swallowing)
Esophagus (Throat) Involvement
Esophagus: Reflux (Heartburn)
Gastroparesis Stories
GAVE (Watermelon Stomach)
Loss of Appetite
Additional Research

Overview: GI Involvement in Systemic Sclerosis (Scleroderma)

GI involvement consists of a variety of symptoms and conditions that include nausea and vomiting, difficulty with swallowing, constipation, diarrhea, GERD (gastroesophageal reflux disease), problems with digestion, gastroparesis, and watermelon stomach.

Some of these symptoms are bothersome and can have a serious affect on your quality of life. Others are life threatening. All should be taken seriously and discussed with your doctor. (Also see Scleroderma Gastrointestinal Involvement, What is Scleroderma?, Types of Scleroderma, and Systemic Sclerosis

Gastrointestinal manifestations on impaired quality of life in systemic sclerosis (SSc). Gastrointestinal involvement is frequent in SSc, with reflux or indigestion as the most common symptom. PubMed, J Dig Dis, 2019 May;20(5):256-261. (Also see Quality of Life)

Intestinal Involvement in Systemic Sclerosis (SSc): A Clinical Review. Multidisciplinary approach of intestinal manifestations in SSc by gastroenterologists and rheumatologists is required for optimum management. PubMed, Dig Dis Sci, 2018 Apr;63(4):834-844.

Evaluation and management of esophageal manifestations in systemic sclerosis (SSc). This review summarizes our knowledge concerning the evaluation and management of esophageal manifestations in SSc patients, including emerging therapeutic modalities. PubMed, Ann Gastroenterol, 2018 Mar-Apr;31(2):165-170.

Biomarkers for GI Involvement in Systemic Scleroderma

Worsening of esophageal dilatation is associated with increase in a high-resolution computed tomography (HRCT) score in early systemic sclerosis-associated interstitial lung disease (Ssc-ILD). Our study cohort found that a worsening esophageal diameter was a predictor of progression of lung fibrosis determined by HRCT score in early SSc-ILD. PubMed, Clin Rheumatol, 08/15/2020. (Also see Correlation between Pulmonary Fibrosis and other Diseases or Complications)

Severe gastrointestinal disease (GI) in very early systemic sclerosis (SSc) is associated with early mortality. Severe GI disease is common in early SSc and is associated with significant morbidity and increased mortality. PubMed, Rheumatology (Oxford), 12/04/2018.

Gastrointestinal (GIT) and Hepatic Disease in Systemic Sclerosis (SSc). Proper diagnostics and therapeutics for SSc-GIT involvement require the treating physician to have an understanding of an integrated approach and potential medication adverse effects. PubMed, Rheum Dis Clin North Am, 2018 Feb;44(1):15-28.

Consider GERD in patients with pulmonary diseases. Gastroesophageal reflux disease (GERD) has been linked to many forms of pulmonary disease. However, because not all presentations of lung diseases include GERD’s more commonly recognized symptoms, it may be missed as a contributing factor. American College of Physicians. (Also see Correlation between Pulmonary Fibrosis and other Diseases or Complications)

Sleep disturbances in systemic sclerosis (SSc): evidence for the role of gastrointestinal symptoms, pain and pruritus. Gastrointestinal symptoms, pain and pruritus were associated with sleep disturbance in SSc. Additional research is needed on sleep in SSc so that well-informed sleep interventions can be developed and tested. PubMed, Rheumatology. (Also see Sleep Disorders and Scleroderma, Pain, and Scleroderma Skin Involvement: Itching)

Digestive Involvement

Systemic scleroderma can affect the entire digestive tract, affecting swallowing, digestion, and elimination.

(PDF) The UCLA SCTC GIT 2.0 Questionnaire. This patient questionnaire evaluates gastrointestinal involvement in systemic sclerosis. Patients may complete this questionnaire and take it to their doctors. It is also a valuable tool for evaluating clinical trials. Dinesh Khanna, MD, MSc.

Bowel Involvement

Bowel Involvement. Scleroderma can cause constipation, diarrhea, malabsorption, diminished peristalsis, intestinal pseudo-obstruction, and bowel incontinence. Typical in the initial stages of scleroderma is chronic constipation, sometimes alternating with diarrhea. Late stage scleroderma bowel involvement is often marked by diarrhea, malabsorption, and bowel incontinence. ISN.

Causes of Bowel Dysfunction
Constipation: Treatments
Diarrhea: Treatments
Bowel Incontinence
Bowel Management
Bowel Perforation
Bowel Surgery
Habba Syndrome
Intestinal Pseudo-Obstruction
Intestinal Bacterial Overgrowth
Inflammatory Bowel Disease (IBD)
—Collagenous Colitis
—Crohn's Disease
—Ulcerative Colitis
Irritable Bowel Syndrome (IBS)

Dysmotility Syndrome

Dysmotility syndrome refers to muscles in the gastrointestinal tract not working properly. This can include the throat (esophagus), stomach, and bowels. When the stomach is affected, it is often called gastroparesis. When it affects the bowels, it may be called intestinal pseudo-obstruction. ISN. (Also see Esophagus, Gastroparesis, and Bowel Involvement)

Correlation with other Complications

Dysphagia (Difficulty Swallowing)

Dysphagia is the medical term for difficulty in swallowing. Symptoms include a sensation of food sticking in the throat, chest pressure or 'burning' after eating, or a feeling of choking. Dysphagia can be due to many different things. Occasionally it is one of the symptoms of systemic scleroderma. ISN.

Dysphagia Treatments
Liquefied Food for Dysphagia
Enteral or Parenteral Nutrition (TPN)
Dysphagia Personal Stories

Esophagus (Throat)

Esophageal (Throat) Involvement. Scleroderma can cause Barrett's Esophagus, esophageal diseases, esophageal stricture, and esophageal ulcers. ISN.

Air Esophagogram
Barrett's Esophagus
Candida Esophagitis
Correlation with Lung Disease
Dysphonia (Hoarseness, Loss of Voice)
Esophageal Diseases
Esophageal Motility Disorders
Esophageal Spasm
Esophageal Stricture
Esophageal Ulcer
Gastric MALT Lymphoma
Reflux (Heartburn)

Esophagus: Reflux (Heartburn)

Esophagus: Reflux (Heartburn) and GERD. There are many effective treatments and lifestyle modifications for reflux (heartburn) which is very common in scleroderma patients. ISN.

Cough Due to Heartburn
Heartburn, GERD and Scleroderma
About Reflux (Heartburn)
Hiatal Hernia
About GERD
Reflux and Atrial Fibrillation
Reflux and Lung Involvement
Reflux Prevention and Treatments
Personal Stories


What is Gastroparesis? Symptoms, diagnosis, treatments, and support. Gastroparesis and Dysmotilities Association.

Gastroparesis Personal Stories

Jason: Linear Scleroderma I have recently been diagnosed with Raynaud's as well, have had gastrointestinal difficulties more common to systemic forms, and have witnessed these lesions grow and deepen rather than decrease in size…

Jody: Fibromyalgia/Difficult Diagnosis In Sudan, I was on IV for heat stroke and food poisoning. And in Thailand, at the end of March, it all came to a crashing halt…

Sandy J: CREST Scleroderma I have had an ileostomy for two years and a feeding peg for just over one year, and would appreciate comments from any person who also has one or both of these problems…

Tami: Morphea Scleroderma I have gotten used to the stares everyone casts my way because in their eyes I am different. Unique, I guess…

Trish: Spouse of a Diffuse Scleroderma Patient My husband was diagnosed with scleroderma in June of 2000…

Loss of Appetite

A loss of appetite can occur for a great many reasons, including anxiety, depression, infection, medication and treatment side-effects, and many illnesses. There are medications that can stimulate appetite, as well as treat nausea. Loss of appetite in a scleroderma patient may be indicative of gastrointestinal involvement. If appetite loss persists, it is important to consult your medical care provider.


Serum albumin is not useful as a marker for malnutrition in scleroderma.

Nutritional status and predictors of weight loss in patients with systemic sclerosis (SSc). Nutritional risk and gastrointestinal involvement are frequent and closely correlated in patients with SSc. PubMed, Clin Nutr ESPEN, 2020 Dec;40:164-170. (Also see Diet and Systemic Scleroderma)

Microbiome Dysbiosis Is Associated With Disease Duration and Increased Inflammatory Gene Expression in Systemic Sclerosis Skin. Microbiome dysbiosis is associated with disease duration and increased inflammatory gene expression. PubMed, Arthritis Res Ther, 2019 Feb 6;21(1):49. (Also see Diet and Scleroderma)


Case Report: Benign Spontaneous Pneumoperitoneum in Systemic Sclerosis (SSc). We report a case of spontaneous pneumoperitoneum (air or gas in the abdominal (peritoneal) cavity) without evidence of peritoneal irritation in a malnourished patient with long-standing SSc. PubMed, J Clin Rheumatol.

Watermelon Stomach

Watermelon Stomach is the popular name for Gastric Antral Vascular Ectasia (GAVE) — a condition in which the lining of the stomach bleeds, causing it to look like the characteristic stripes of a watermelon when viewed by endoscopy. ISN.

What is Watermelon Stomach?
A Patient's Perspective
Watermelon Stomach in Associated with Other Diseases
Patient/Caregiver Stories

Additional Research

Sustained benefit from intravenous immunoglobulin therapy for gastrointestinal involvement (GI) in systemic sclerosis (SSc). Sustained benefit from IVIG suggests a specific immunomodulatory effect on those with established SSc GI complications. PubMed, Rheumatology (Oxford). (Also see IVIg)

Nausea and Vomiting Many illnesses can cause stomach pain, nausea and vomiting. Some are mild sicknesses that will pass by themselves, but others are serious and need medical attention.

Go to Bowel Dysfunction

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