Abstract: It is estimated that approximately 90% of patients with scleroderma have gastrointestinal tract involvement. The pathophysiology may due to collagen deposition, autoantibodies, smooth muscle cell inflammation and atrophy, and the characteristic fibrosis. Major manifestations include gastroesophageal reflux disease(GERD), Barrett’s esophagus, gastroparesis, intestinal pseudo-obstruction, small intestinal bacterial overgrowth(SIBO), and constipation. Early recognition and treatment are important. Patients with scleroderma should receive proton pump inhibitors(PPI) treatment to prevent GER complications, and also possibly to prevent or slow the progression of interstitial lung disease(ILD). Prokinetics are more effective in the early stages of the disease. More and more research demonstrated the benefits of antibiotic therapy for gastrointestinal complications. Mortality due to significant malnutrition has been estimated to be 20%.