Paediatric Rheumatology - Special Articles
Evaluation of the gastrointestinal tract in juvenile systemic sclerosis: the paediatric gastroenterologist perspective
A. Krasaelap1, R.E. Borlack2, J. Garcia-Marin3, L.A. Robinson4, E. Willis5, S.C. Li6, N. Vasquez-Canizares7, O. Kasapcopur8, A. Gunalp9, L. Ambartsumyan10
- Division of Gastroenterology and Hepatology, Seattle Children’s Hospital, University of Washington, Seattle, WA, USA.
- Division of Gastroenterology and Nutrition, Children’s Hospital at Montefiore Einstein, Bronx, NY, USA.
- Division of Gastroenterology and Nutrition, Children’s Hospital at Montefiore Einstein, Bronx, NY, USA.
- Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, NY, USA.
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children's Hospital, UK.
- Department of Paediatrics, Division of Paediatric Rheumatology, Hackensack Meridian School of Medicine, Joseph M. Sanzari Children's Hospital, Hackensack, NJ, USA.
- Department of Pediatrics, Division of Pediatric Rheumatology, Children’s Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY, USA.
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey.
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey.
- Division of Gastroenterology and Hepatology, Seattle Children’s Hospital, University of Washington, Seattle, WA, USA. lusine.ambartsumyan@seattlechildrens.org
CER20298
2026 Vol.44, N°8
PI 1670, PF 1679
Paediatric Rheumatology - Special Articles
Free to view
(click on article PDF icon to read the article)
PMID: 42635158 [PubMed]
Received: 03/07/2026
Accepted : 24/07/2026
In Press: 04/08/2026
Published: 19/08/2026
Abstract
The gastrointestinal (GI) tract is one of the most affected organs in systemic sclerosis (SSc), described in 42-78% of children with juvenile-onset SSc (jSSc). GI disease negatively impacts quality of life and increases disease-specific morbidity and mortality. Immune-mediated vascular, mucosal and neuromuscular compromise of the GI tract results in heterogeneous disease and variable clinical symptoms, severity, and disease progression. The burden of GI disease has a significant impact on clinical outcomes, and yet diagnosis and monitoring of GI disease remain challenging. The problem is multifactorial and includes symptoms that are non-specific and often overlooked, poor correlation between GI symptoms and testing, and limitations of GI-specific diagnostic testing. This review describes the clinical presentation and diagnostic work-up of upper and lower GI disease in jSSc via three distinct clinical scenarios, each encompassing a different segment of the GI tract (oropharynx/oesophagus, stomach/small bowel, colon/anorectum). Specifically, it highlights that the assessment of GI disease in jSSc warrants a high level of suspicion, timely evaluation, proper diagnostic testing, and most notably multidisciplinary collaboration.
