The gastrointestinal tract can be affected by rheumatologic and vasculitic conditions and is an important cause of morbidity and mortality in this patient population [1]. General symptoms of weight loss, fever, and change in bowel symptoms are critical aspect of a rheumatologic history [2]. Prompt diagnosis is important for targeted treatment [3]. The evaluation should determine whether disease activity or damage is responsible for symptoms, which often diagnostically approached by anatomical location. The approach for targeted assessment of gastrointestinal tract symptoms may include a combination of physical exam, questionnaires, laboratory, and imaging studies. While physical exam can be quite limited with regards to diagnosis, the oropharyngeal exam can be supportive of a diagnosis of Sjogren’s disease or systemic sclerosis, the rectal exam can identify the etiology of incontinence, and an abdominal exam can help guide urgent imaging needs for complications of rheumatologic and vasculitic conditions (Fig. 1.1). A methodical approach to gastrointestinal tract symptoms is necessary in patients with rheumatologic disease to guide treatment.