Gastrointestinal Involvement in Scleroderma: Gastroenterology | May 2026

Summary

Systemic sclerosis (SSc), the systemic form of scleroderma, is a multisystem disorder characterised by fibrosis, vasculopathy, and immune dysregulation. Gastrointestinal involvement is extremely common, affecting up to 90% of patients, with the oesophagus being the most frequently involved organ. However, the disease can affect the entire gastrointestinal tract—from the oesophagus to the anorectum.

The central pathophysiological process is smooth muscle atrophy and fibrosis, leading to impaired motility. This results in stasis, dilation, and a cascade of complications. Clinically, patients may present with dysphagia and reflux due to oesophagal involvement, gastroparesis and gastric vascular lesions, small intestinal bacterial overgrowth and pseudo-obstruction, and colonic dysmotility causing constipation or megacolon. Anorectal involvement may lead to faecal incontinence due to sphincter weakness.

A key challenge is that symptoms often correlate poorly with objective pathology, making diagnosis and monitoring difficult. Furthermore, therapeutic evidence is limited, and most treatment strategies are extrapolated from non-scleroderma populations.

Management requires a high index of suspicion, segment-wise evaluation, and individualised therapy, focusing on symptom control and prevention of complications. Gastroenterologists must recognise that gastrointestinal disease in SSc is not isolated but part of a systemic fibrotic and vascular disorder, requiring a tailored and multidisciplinary approach.