Early GI Involvement Predictive of Scleroderma Outcomes Save

Gastrointestinal involvement is among the most prevalent and burdensome complications of systemic sclerosis (SSc), yet whether early GI symptoms predict future disease trajectory has been unclear. The GENISOS Cohort study addressed disease outcomes. 

A total of 450 participants with early SSc (≤5 years from first non-Raynaud's symptom) underwent baseline assessment of six GI symptoms — GERD, dysphagia, bloating, constipation, diarrhea, and peptic ulcer disease. Significant GI involvement was defined as a Medsger GI severity score ≥2. Cox proportional hazards models evaluated associations between baseline symptoms and two outcomes: progression to significant GI disease and all-cause mortality.

Patients were predominantly female (84%), with a mean age of 47.7 years. Baseline GI symptoms were common — GERD in 76% and dysphagia in 41%. At enrollment, 4% already had significant GI disease; ultimately 13% reached that threshold during follow-up.

For GI progression, baseline GERD (HR 4.15, p=0.019) and diarrhea (HR 2.25, p=0.021) were the strongest individual predictors. Notably, each additional baseline GI symptom independently raised the hazard of significant GI progression by 53% (p=0.003), underscoring the importance of cumulative symptom burden rather than any single symptom alone.

Mortality risk followed a similar pattern. Peptic ulcer disease (HR 2.21, p=0.007) and diarrhea (HR 1.48, p=0.045) each independently predicted death, and every additional GI symptom at baseline increased mortality risk by 29% (p<0.001).

 In early SSc, both individual GI symptoms and overall GI symptom burden are meaningful predictors of future GI disease.