Systemic sclerosis gastrointestinal disease — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateConnective Tissue DiseasesSystemic sclerosis gastrointestinal diseaseSCE Rheumatology

A 58-year-old woman with limited systemic sclerosis has bloating, diarrhoea and weight loss. She has long-standing reflux and telangiectasia. Blood tests show low B12 and folate, and hydrogen breath testing is positive. There is no blood in stool. What is the most important complication to screen for?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Small intestinal bacterial overgrowth

Explanation lettering: B = shown as A · C = shown as B · A = shown as C · E = shown as D · D = shown as E

Small intestinal bacterial overgrowth is best because systemic sclerosis gut dysmotility predisposes to small intestinal bacterial overgrowth causing bloating, diarrhoea, weight loss and vitamin deficiency. B is less suitable because ulcerative colitis would usually cause bloody diarrhoea and colitis features; C is less suitable because pancreatic cancer is possible in weight loss but the breath test and systemic sclerosis context support SIBO; D is less suitable because acute mesenteric ischaemia presents with severe acute pain; E is less suitable because coeliac disease may cause malabsorption but does not explain scleroderma dysmotility pattern as well. Clinical pearl: GI involvement in systemic sclerosis extends beyond reflux and can cause malnutrition.

Reference: BSR systemic sclerosis guideline 2024