Symptomatic but Not Sufficient: Implication Testing of Esophageal Dysmotility in Systemic Sclerosis

Esophageal dysmotility (ED) affects approximately 70–90% of patients with systemic sclerosis (SSc) and is among the most prevalent and disabling gastrointestinal manifestations. Despite high prevalence, ED is frequently asymptomatic. Four clinical implications are commonly stated: that diffuse cutaneous SSc (dcSSc) subtype, anti-Scl70 antibody, dysphagia symptoms, and esophageal dysmotility itself each imply ED or its downstream complication (PPI-refractory GERD). Using the PAC-bound implication testing framework (Ritschel & Claude, 2026), we evaluated these implications in a synthetic SSc cohort (n=800) calibrated to Roman et al. (2011) and Ebert et al. (2012). Anti-Scl70 esophageal dysmotility received a MODERATE ⇒verdict (violation rate 13.5%, PAC