How should I approach the management of gastrointestinal symptoms in a patient with scleroderma?

Management of gastrointestinal symptoms in systemic sclerosis requires a comprehensive, symptom-targeted approach due to the multifactorial nature of GI involvement in this condition. Initial assessment should focus on identifying specific symptoms such as dysphagia, gastro-oesophageal reflux, bloating, and constipation, as these are common manifestations ¹. Proton pump inhibitors (PPIs) are the mainstay for managing gastro-oesophageal reflux disease (GORD), which is prevalent in systemic sclerosis, to reduce acid exposure and prevent complications ¹,⁴. Prokinetic agents may be considered to improve oesophageal motility and gastric emptying, although evidence is limited and should be tailored to individual tolerance ¹.

For small bowel involvement, including symptoms of malabsorption or pseudo-obstruction, careful evaluation is essential to exclude complications such as pneumatosis intestinalis, which can occur in systemic sclerosis and requires specialist input (Jassal et al., 2025). Management includes supportive care, nutritional support, and cautious use of antibiotics if bacterial overgrowth is suspected ¹ (Jassal et al., 2025). Regular monitoring and multidisciplinary collaboration with gastroenterology and rheumatology teams are critical to optimize outcomes ¹ (Jassal et al., 2025).

In summary, the approach integrates symptom control with acid suppression, prokinetics, nutritional support, and vigilance for serious complications such as pneumatosis intestinalis, guided by clinical assessment and specialist advice ¹ (Jassal et al., 2025).