Study ties acid reflux, bloating to fatigue in scleroderma

Certain digestive symptoms — bloating and chronic acid reflux — are associated with clinically relevant fatigue in people with systemic sclerosis, a study found.

The study involved more than 100 people with SSc, also known as scleroderma. Patients with clinically relevant fatigue also had greater difficulties with everyday activities and more limitations in life choices.

“Our findings suggest that the well-established relationship between GI [gastrointestinal] involvement and fatigue in SSc is not uniform across the GI manifestations but appears to be primarily associated with a distinct profile of patient-reported symptoms,” the researchers wrote.

The study, “A distinct gastrointestinal symptom profile characterizes clinically relevant fatigue in systemic sclerosis,” was published in Clinical Rheumatology.

Recommended Reading

July 14, 2026 News by Andrea Lobo, PhD

Scleroderma added to NIH project targeting autoimmune diseases

Drilling down on symptoms

SSc is an autoimmune disease that can affect the skin, as well as internal organs, including the heart, kidneys, lungs, and digestive tract.

Fatigue is one of the most common symptoms of SSc, often having a substantial impact on patients’ daily activities and quality of life. Digestive problems have consistently been associated with greater fatigue in people with SSc, but studies have generally looked at overall gastrointestinal involvement rather than individual symptoms.

To learn more, a team led by researchers in Italy investigated which specific gastrointestinal symptoms are associated with clinically relevant fatigue in people with SSc. The study involved 115 participants (mean age 62, 80% women), of whom 42 (36.5%) had clinically relevant fatigue, as defined by the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale.

Participants with clinically relevant fatigue were more frequently women (90.5% vs. 74%) and were significantly more likely to have gastrointestinal symptoms and to experience them in more severe forms than those without such fatigue. These included gastroesophageal reflux disease (GERD), or chronic acid reflux (90.5% vs. 60.3%), difficulty swallowing (40.5% vs. 16.4%), bloating (66.7% vs. 15.1%), and diarrhea (28.6% vs. 11%). GERD occurs when stomach acid flows back into the esophagus, the tube connecting the throat to the stomach, and causes heartburn.

Patients with fatigue more frequently had itching and fibromyalgia — a long-term condition marked by widespread musculoskeletal pain, fatigue, and sleep problems — than those without fatigue. No significant differences were observed regarding skin and lung involvement, SSc subtype, inflammatory markers, or which self-reactive antibodies (autoantibodies) they had.

Participants with clinically relevant fatigue also reported a greater symptom and functional burden, particularly related to acid reflux, bloating, and diarrhea, as well as poorer social functioning and emotional well-being. They also had a harder time with everyday activities, more limitations in life choices, and worse hand function, body mobility, pain, shortness of breath, and bodily pain.

SSc patients with fatigue had poorer quality of life, particularly in the areas of bodily pain, energy and fatigue, and social functioning.

When accounting for all five gastrointestinal symptoms (GERD, difficulty swallowing, bloating, diarrhea, and constipation), participants with bloating had about nine times higher odds of clinically relevant fatigue, while those with GERD had about four times higher odds. Difficulty swallowing was also often associated with fatigue. The association remained significant for GERD and bloating after adjusting for sex, fibromyalgia, digital ulcers (open sores on the fingers or toes), and itching.

“This study provides a more granular characterization of the GI correlates of fatigue and supports future longitudinal studies incorporating objective assessments of GI dysfunction,” the researchers wrote.

The scientists noted that the study design “does not allow determination of whether GI symptoms contribute to fatigue or whether more fatigued patients simply perceive and report greater symptom burden.” They also said factors such as nutritional status, sleep issues, and physical activity “were not comprehensively evaluated and may also contribute to fatigue severity.”