The aim of this retrospective study was to evaluate the initial video-radiology and manometry in 40 consecutive patients with systemic sclerosis (n=21) or suspected systemic sclerosis (n = 19) in relation to oesophageal symptoms; and, furthermore, to evaluate the consequence of radiographic or manometric findings in the oesophagus on diagnosis and treatment. Evaluating oesophageal abnormalities in relation to diagnosis and treatment has, to our knowledge, not been reported before. Video-radiology together with manometry demonstrated oesophageal dysfunction in 80% of patients. Thirteen patients (33%) were asymptomatic in spite of identified motility abnormalities. Following the radiographic and manometric investigation, 9 patients (23%) had a change of diagnosis and, in 20 patients (50%), systemic treatment was instituted or intensified. The study confirms that both manometry and video-radiology are important for the identification of oesophageal motility abnormalities in patients with systemic sclerosis. Oesophageal symptom profiles alone do not predict abnormal findings.