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. 2025 Sep 5:keaf457.
doi: 10.1093/rheumatology/keaf457. Online ahead of print.

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

Francesco Bonomi  1   2 , Cosimo Bruni  1   3 , Silvia Peretti  1   2 , Rossella De Angelis  4 , Gianluigi Bajocchi  5 , Dilia Giuggioli  6 , Martina Orlandi  6 , Giovanni Zanframundo  7 , Rosario Foti  8 , Giovanna Cuomo  9 , Alarico Ariani  10 , Edoardo Rosato  11 , Gemma Lepri  2 , Francesco Girelli  12 , Valeria Riccieri  13 , Elisabetta Zanatta  14 , Silvia Laura Bosello  15 , Ilaria Cavazzana  16 , Francesca Ingegnoli  17 , Maria De Santis  18 , Fabio Cacciapaglia  19   20 , Giuseppe Murdaca  21 , Giuseppina Abignano  22 , Pettiti Giorgio  23 , Alessandra Della Rossa  24 , Maurizio Caminiti  25 , Anna Maria Iuliano  26 , Giovanni Ciano  27 , Lorenzo Beretta  28 , Gianluca Bagnato  29 , Ennio Lubrano  30 , Ilenia De Andres  31 , Luca Idolazzi  32 , Marta Saracco  33 , Cecilia Agnes  34 , Corrado Campochiaro  35 , Edoardo Cipolletta  4 , Marco Fornaro  19 , Federica Lumetti  6 , Amelia Spinella  6 , Luca Magnani  5 , Giacomo De Luca  35 , Veronica Codullo  7 , Elisa Visalli  8 , Carlo Iandoli  9 , Antonietta Gigante  11 , Greta Pellegrino  36   37 , Erika Pigatto  38 , Maria Grazia Lazzaroni  16 , Enrico De Lorenzis  15 , Gianna Mennillo  22 , Marco Di Battista  24 , Giuseppa Pagano-Mariano  25 , Federica Furini  39 , Licia Vultaggio  39 , Simone Parisi  40 , Clara Lisa Peroni  40 , Gerolamo Bianchi  41 , Enrico Fusaro  40 , Gian Domenico Sebastiani  26 , Marcello Govoni  39 , Salvatore D'Angelo  22 , Franco Cozzi  38 , Franco Franceschini  16 , Serena Guiducci  2 , Lorenzo Dagna  35 , Andrea Doria  14 , Carlo Salvarani  6 , Maria Antonietta D'Agostino, Florenzo Iannone  19 , Clodoveo Ferri  6   42 , Marco Matucci-Cerinic  35 , Silvia Bellando Randone  1 ; SPRING-SIR (Systemic Sclerosis PRogression INvestiGation group of the Italian Society for Rheumatology)
Affiliations
Free article

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

Francesco Bonomi et al. Rheumatology (Oxford). .
Free article

Abstract

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.

Keywords: Autoantibodies; Disease progression; Esophageal dysmotility; Gastrointestinal involvement; Systemic sclerosis; VEDOSS.

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