Rheumatic diseases (RD) frequently affect gastric structure and function through a combination of chronic inflammation, autonomic dysregulation, microvascular injury, and progressive fibrosis. These manifestations are often slowly progressive, contributing to delayed diagnosis. This chapter reviews common gastric complications such as gastric antral vascular ectasia (GAVE), gastroparesis, peptic ulcer disease (PUD), atrophic or autoimmune gastritis, localized amyloidosis, and hiatal hernia. These conditions are discussed in the context of systemic sclerosis (SSc), systemic lupus erythematosus (SLE), Sjögren’s syndrome, rheumatoid arthritis (RA), and Ehlers Danlos syndrome. Several management strategies exist, often similar to treating the complication in the general population, though they may need to be further clarified in the specific context of RD to improve long-term outcomes.