Gastric disease in systemic sclerosis: Spectrum, challenges, and insights from a systematic literature review

Gastric complications in systemic sclerosis (SSc) are common, clinically diverse, and often overlooked, despite their profound impact on patient quality of life. This review synthesizes current evidence on prevalence, clinical relevance, and diagnostic strategies, while identifying key gaps and proposing priorities to advance care and research.

A systematic review was conducted per PRISMA guidelines and registered with PROSPERO. MEDLINE, EMBASE, and Web of Science were systematically searched (September 2024). Included studies addressed gastric manifestations in SSc, such as dysmotility, gastric antral vascular ectasia (GAVE), mucosal abnormalities, and/or Helicobacter pylori, and reported on prevalence, clinical impact, or diagnostic approaches.

Of 123 full-text articles, 37 met our specified inclusion criteria. Gastric dysmotility was frequent, with delayed emptying in 18-64 % and bradygastria in 12-70 %. GAVE prevalence ranged from 0 to 22.3 % and was negatively associated with anti-topoisomerase-I and variably associated with anti-RNA polymerase III antibodies. Mucosal abnormalities (e.g., gastritis, ulcers, cancer) were common but inconsistently defined. Helicobacter pylori prevalence varied widely (10-78 %), with lower detection via biopsy or breath testing than serology. Associations between objective findings and patient-reported outcomes (PROs) were inconsistent and underexplored; data on gastric-specific mortality were limited.

Gastric disease in SSc is underrecognized, yet clinically significant. Progress necessitates standardized diagnostics (scintigraphy, breath tests, electrogastrography), validated patient-reported outcomes (PROs), and longitudinal studies to better define disease burden, optimize screening, and guide targeted therapies that improve outcomes and quality of life in SSc.