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Introduction Gastroesophageal involvement, particularly reflux, has been identified as a risk factor for development and progression of interstitial lung disease (ILD) in adult systemic sclerosis However, this association has not yet been extensively studied in juvenile systemic sclerosis (jSSc). To further address this gap, the juvenile systemic scleroderma inception cohort(jSScIC) including 279 patients provides an opportunity to investigate the potential link between these two manifestations in the paediatric population.Material and Methods We analysed baseline clinical data from all patients enrolled in jSScIC till April 15 th, 2025 and compared the clinical characteristics of patients with and without GR.Results We reviewed data of 279 patients: 93 (33%) had reported to have gastroesophageal reflux (GR+). Patients with GR+ were more frequently evaluated by barium swallow (32% versus 18%, p=0.006) and endoscopy (22% versus 5%, p=0.041). Approximately 70% of the patients had diffuse cutaneous subset. The Median age at onset of first non-Raynaud presentation was around 11 years. Patients with GR+ had more nailfold capillary changes (91% versus 71%, p=0.001) and telangiectasia (49% versus 30%, p=0.002) compared to GR negative (GR-) patients. GR+ patients were more likely to have lung involvement than GR- patients with higher frequency had FVC< 80% (p=0.05), DLCO< 80% (p=0.001) and ILD as identified by high-resolution CT (p=0.004). The pulmonary function findings GR+ patients had more positive findings for ILD on high resolution CT of the lung as GR- patients (56% versus 37%, p=0.004). No significant differences were observed regarding autoantibody profile, cardiac, renal and musculoskeletal involvement between the groups.Conclusions GR+ had a significantly higher prevalence of ILD. Patients reported GR is correlating with an increased frequency of microvascular changes. This findings highlight the importance of assessing all patients for GR to enable timely management of reflux and potentially reduce occurrence/progression for ILD in jSSc. Further long-term studies are needed to prove our hypothesis and support targeted intervention strategies.Abstract P.336 Table 1Baseline characteristics of patients with and without gastroesophageal reflux in the jSScIC cohort, where we found clinically meaningful difference