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Introduction Gastrointestinal (GI) involvement is a frequent and clinically significant manifestation of systemic sclerosis (SSc), yet research has disproportionately focused on esophageal complications. In contrast, gastric dysmotility—particularly delayed gastric emptying—remains underexplored, despite its potential to substantially influence patient symptoms, nutritional status, and overall disease outcomes.Material and Methods We conducted a retrospective cohort study of patients with SSc at a tertiary care center between 2018 and 2024. All participants underwent a standardized 4-hour solid gastric emptying scintigraphy. Gastric dysmotility was defined as more than 20% gastric retention at 4-hours. Clinical and demographic characteristics were retrieved from a prospectively collected database. We examined associations between gastric dysmotility and demographic, clinical, and immunologic characteristics of SSc. To examine the relationship between gastric dysmotility and clinically significant outcomes, defined as a composite of SSc-related mortality or lung transplantation, we performed time-to-event analyses using Kaplan–Meier survival curves, with follow-up beginning at the time of cohort inclusion. Independent associations between gastric dysmotility and outcomes were further examined using a multivariable Cox regression analysis.Results Ninety-four patients were included (mean age 48 ±12 years; 81% female; mean disease duration 8±5 years). Gastric emptying scintigraphy was compatible with gastric dysmotility in 33 patients (35%). Compared with those without gastric dysmotility, patients with gastric dysmotility had a higher prevalence of interstitial lung disease (64% vs. 40%, p=0.033) and were more likely to exhibit absent esophageal contractility (76% vs. 46%, p<0.001). Gastric dysmotility was less frequent in patients with anti-centromere antibodies (27% vs. 56%, p=0.009) but more common in those with anti-U1RNP antibodies (16% vs. 2%, p=0.020). During the observation period, 16 patients (18%) met the composite endpoint of either SSc-related death or lung transplantation. Time-to-event univariate analyses demonstrated a significant association between gastric dysmotility and worse outcomes, confirmed on Kaplan–Meier curves (log-rank chi square=13.8, p<0.001 figure 1). In a multivariable Cox regression analysis adjusted for potential confounders (sex, diffuse subset, disease duration, absent esophageal contractility and interstitial lung disease) gastric dysmotility remained independently associated with adverse outcomes (HR 4.23, 95% CI 1.25–14.33, p=0.051).Conclusions In SSc, our data shows that gastric dysmotility is associated with a distinct autoantibody profile and determined that it independently predicts serious adverse outcomes. These findings underscore the importance of objective gastric function assessment and its potential role in risk stratification.Conclusions Initial therapy was associated with improved survival and reduced PAH progression in SSc-PAH, with consistent effects across haemodynamic thresholds and risk strata. These findings support guideline-recommended early intervention, highlight the importance of high-quality observational data in rare diseases, and underscore the need for RCTs to clarify treatment effects in patients with milder haemodynamic impairment.Abstract OC.51 Figure 1