Introduction: Interstitial lung disease (ILD) in systemic sclerosis (SSc) patients is associated with increased morbidity and mortality. Gastro-esophageal reflux (GER) is considered a contributing factor in the pathogenesis of ILD. Aim: To characterize gastro-esophageal reflux (acid and non-acid) in SSc patients with and without ILD. Methods: Patients with SSc underwent pulmonary high-resolution computer tomography (HRCT) scan and 24-h impedance-pH monitoring off-PPI therapy. The presence of pulmonary fibrosis was assessed using validated HRCT-scores. Reflux monitoring parameters included number of acid and non-acid reflux episodes, proximal migration of the refluxate and distal esophageal acid exposure. Unless otherwise specified data are presented as median [25th -75th percentile]. Results: Forty consecutive SSc patients (35 female; mean age 53 years; range 24-71; 15 diffuse and 25 limited SSc) were investigated. Eighteen (45%) SSc patients had pulmonary fibrosis (HRCT score 7). SSc patients with ILD had higher (p<0.01) esophageal acid exposure (10.3[7.5-15] vs. 5.2[1.5-11]), higher (p<0.01) number of acid (41[31-58] vs. 19[10-23]) and non-acid (25[20-35] vs. 17[11-19]) reflux episodes and higher (p<0.01) number of reflux episodes reaching the proximal esophagus (42.5[31-54] vs. 15[8-22]) compared to SSc patients with normal HRCT scores. Pulmonary fibrosis scores (HRCT-score) correlated well with the number of reflux episodes in the distal (r²=0.637) and proximal (r²=0.644) esophagus. Conclusions: SSc patients with ILD have more severe reflux i.e. more reflux episodes and more reflux reaching the proximal esophagus. Whether or not the development of ILD in SSc patients can be prevented by reflux reducing treatments needs to be investigated.