Objective gastrointestinal involvement in patients with systemic sclerosis: Prevalence and clinico-immunological...

Gastrointestinal (GI) involvement is the most frequent visceral manifestation of systemic sclerosis (SSc) and is associated with increased morbidity and mortality. To date, its characterization using specific diagnostic tests has been poorly described in the Spanish population.

A cross-sectional study was conducted including patients with SSc enrolled in the Spanish Multidisciplinary Scleroderma Registry (REMSCLE) up to April 2024 who had undergone at least one GI diagnostic test. Objective GI involvement was defined as the presence of pathological findings in any of these tests. Clinical, immunological, and functional characteristics were compared between patients with and without objective GI involvement.

A total of 816 patients were included, of whom 492 (60.3%) presented objective GI involvement, with esophageal dysmotility being the most frequent finding (77.3%). GI involvement was associated with an earlier disease onset (46.2 vs. 50.7 years; P=.002), a higher prevalence of the diffuse subtype (23.2% vs. 14.8%; P=.003), and more vascular manifestations, including digital ulcers (42.8% vs. 34.7%; P=.021), telangiectasias (72.0% vs. 63.0%; P=.008), and non-inflammatory myopathy (11.3% vs. 4.4%; P=.015). Patients with GI involvement also showed a higher prevalence of interstitial lung disease (51.4% vs. 39.2%; P=.001) and cardiac involvement (41.3% vs. 28.0%; P<.001). In addition to a distinct immunological profile, a lower frequency of anti-centromere antibodies (43.0% vs. 53.7%; P=.004) and a higher prevalence of anti-U1RNP antibodies (6.5% vs. 3.1%; P=.043) were observed.

Objective GI involvement in the REMSCLE cohort is highly prevalent and is associated with more severe clinical phenotypes, multiorgan involvement, and specific serological profiles, underscoring the need for systematic and early evaluation of GI tract involvement in patients with SSc.