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

Factors associated with development of gastrointestinal problems in patients with scleroderma: a systematic review. Longitudinal observational studies are warranted, as there is insufficient evidence to describe the risk factors for GI problems in patients with scleroderma. PMC, 12/30/2015.

Systemic Sclerosis: Gastrointestinal Disease and Its Management. Recent studies on the pathophysiology of the disease highlight new mechanisms to explain gastrointestinal dysmotility, but treatment remains symptomatic. PubMed, Rheum Dis Clin North Am, 2015 Aug;41(3):459-73.

Study Demonstrates Benefits of Medical Nutrition Therapy (MNT) Intervention in Systemic Sclerosis (SSc) Patients with Gastrointestinal Involvement (GI). Future studies should include direct measures of body composition and should seek to determine the durability of MNT on symptom improvement in a larger number of patients with SSc involving the GI tract. Scleroderma News, 07/27/2015. (Also see Diet and Scleroderma)

Evaluation and management of gastrointestinal manifestations in scleroderma (SSc). Patient care is being optimized by close collaboration of rheumatologists and gastroenterologists, leading to a more coordinated approach in the management of gastrointestinal manifestations of SSc. PubMed, Curr Opin Rheumatol, 2014 Nov;26(6):621-9.

Evidence for oesophageal and anorectal involvement in very early systemic sclerosis (VEDOSS). In patients with VEDOSS, oesophageal and anorectal disorders are frequently detected, showing that very early SSc is characterised by GI involvement. PubMed, Ann Rheum Dis, 2013 Oct 15.

Systemic sclerosis and the gut. GI complications are common, second only to skin involvement, and affect up to 90% of systemic sclerosis (SSc) patients. PubMed, Expert Rev Gastroenterol Hepatol, 2013 May;7(4):331-9.

Biomarkers for GI Involvement in Systemic Scleroderma

Fecal calprotectin in systemic sclerosis and review of the literature. Abnormal fecal calprotectin levels were correlated with gastrointestinal impairment, especially small intestinal bacterial overgrowth (SIBO). Fecal calprotectin (FC) may be a helpful test in identifying the group of systemic sclerosis patients at high risk for SIBO. PubMed, Autoimmun Rev, 2015 Jun;14(6):547-54. (Also see Systemic Sclerosis Prognosis and Mortality: Biomarkers)

Correlation with Other Symptoms

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, March 2014. (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, 2013 Jun 25. (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.

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 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 as marker for disease activity and severity predicting mortality in patients with systemic sclerosis (SSc). In patients with SSc, malnutrition is common and not identified by Body Mass Index (BMI). Bioelectrical impedance analysis (BIA) parameters reflect disease severity and provide best predictors for patient survival. Therefore, an assessment of nutritional status should be performed in patients with SSc. Lijana Krause. Ann Rheum Dis. May 2010. (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, 2010 Dec;16(8):379-81.

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), 08/28/2015. (Also see IVIg)

Measuring response in the gastrointestinal tract (GIT) in systemic sclerosis. Recommendations are given for trial design and evaluation of GIT involvement in SSc. PubMed, Curr Opin Rheumatol, 2013 Nov;25(6):700-6.

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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