Gastrointestinal involvement in very early and established systemic sclerosis: insights from the SPRING-SIR national Italian registry

Objectives: To describe the prevalence of gastrointestinal (GI) symptoms in systemic sclerosis (SSc) and Very Early Diagnosis of SSc (VEDOSS), identify clinical and serological features associated with GI involvement, and explore a cranio-caudal pattern of symptom distribution, using data from the Italian SPRING-SIR registry. Methods: This cross-sectional analysis included patients fulfilling 2013 ACR/EULAR SSc or VEDOSS criteria. GI involvement was defined as symptoms in at least one GI tract segment and categorized as upper and lower. Associations between GI involvement and clinical variables were assessed using logistic and ordinal regression models, adjusting for demographics, disease characteristics, and autoantibodies. Results: Among 1917 SSc patients, 56% had GI symptoms, associated with longer disease duration, diffuse cutaneous SSc (dcSSc), interstitial lung disease (ILD), digital ulcers (DU), telangiectasias, and tobacco exposure. Extensive GI involvement correlated with more severe disease. Ordinal regression identified female sex, dcSSc, ILD, DU, telangiectasias, tobacco exposure, and anti-centromere antibodies as variables significantly associated with more extensive GI involvement. Disease duration did not show a significant association with GI symptom extent. Among 211 VEDOSS patients, 41.2% reported GI symptoms (mostly esophageal), significantly associated with puffy fingers, and dyspnea. Among VEDOSS, puffy fingers and anti-centromere antibodies were independent predictors of presence of esophageal symptoms. Conclusion: GI involvement in SSc is linked to more severe disease and longer disease duration. Disease duration resulted linked to the presence of GI symptoms rather than extent of GI involvement. Puffy fingers and anti-centromere antibodies may associate with presence of early esophageal symptoms in VEDOSS.