Gastrointestinal ultrasound in systemic sclerosis: A scoping review of current evidence

Systemic sclerosis (SSc) is a rare systemic autoimmune rheumatic disease frequently associated with gastrointestinal (GI) involvement. GI manifestations are heterogeneous, may occur throughout the entire tract from the very early stages of the disease and are often associated with a significant burden of symptoms and complications, leading to high morbidity and mortality. Diagnosis often remains challenging due to the lack of sensitive instruments for early detection and the reliance on invasive or expensive diagnostic tools. In recent years, ultrasound (US) has become an increasingly important tool for GI evaluation across a wide range of conditions, including chronic inflammatory bowel diseases, appendicitis and diverticulitis as well as rarer diseases and functional conditions. The aim of this scoping review is to provide an updated overview of the role of gastrointestinal ultrasound (GIUS) in the assessment and monitoring of GI involvement in SSc. A systematic search of MEDLINE and Scopus identified 25 eligible studies. The available evidence is unevenly distributed across the GI tract: thirteen studies addressed the upper GI tract, seven the anorectum, six the gallbladder and five the mesenteric vessels. For each segment, we summarize how US can detect changes in wall structure, vascularization and motility. The evidence base is limited by small, predominantly single-center and cross-sectional studies, heterogeneous acquisition protocols and reference standards and a scarcity of reproducibility data. Further prospective and multicenter studies are therefore needed to validate the role of GIUS, standardize protocols and establish its integration into the clinical management of SSc patients.