Gastrointestinal problems are common in lupus patients. Most of them are due to infection or adverse reaction to medication, but some serious conditions result from the autoimmune process. It is very important to get a correct diagnosis early, when treatment with corticosteroids and immunosuppressive agents is most likely to be successful.
Symptoms of abdominal pain, nausea, vomiting, diarrhea, and constipation are common in most lupus gastrointestinal illnesses. About 8 to 40 percent of lupus patients have abdominal pain during active disease stages, but not all of these are from autoimmune processes. The most important gastrointestinal conditions to be considered for lupus patients, according to Reference 1, are as follows.
Lupus Mesenteric Vasculitis. This is an inflammation of the blood vessels of the intestines. Blood clots may form due to anti-phospholipid antibodies. Possible triggers include infections, drugs, and chemicals, but the exact cause is unknown. Symptoms may include bloating, loss of appetite, difficulty in swallowing, vomiting blood, and blood in the feces.
Computed tomography (CT) and ultrasonography are used to make the diagnosis. The treatment includes aggressive anti-inflammatory and immunosuppressive drug treatment, plus complete bowel rest. If drugs are not successful, surgery may be required. The authors report that 33 patients who received surgery within 48 hours survived, while 10 of 11 patients who received surgery after 48 hour died.
Protein-Losing Gastroenteropathy. This is characterized by accumulation of fluid in the body, and mimics kidney failure. Blood tests show a loss of albumin. The diagnosis is made primarily by excluding other causes. Tc-99m albumin scintigraphy is a diagnostic test.
Treatment includes corticosteroids, immunosuppressive agents, albumin infusion, nutritional support, and diuretics. Most patients respond well to these treatments.
Intestinal Pseudo-Obstruction. As the name implies, this has the symptoms of an intestinal obstruction. It appears to be caused by a loss of smooth muscle motility. The mortality rate is reported as 18 percent, so early diagnosis and treatment are essential. Besides corticosteroids and immunosuppressive agents, treatment includes antibiotics, parenteral nutrition, and drugs to stimulate small intestine motility.
Pancreatitis. This is a rare but life-threatening complication of lupus. Typical symptoms are abdominal pain, nausea, vomiting, and fever. The diagnosis is based on blood tests. Treatment includes plasmapheresis and intravenous gamma-globulin as well as the standard corticosteroids and immunosuppressive agents.
Other gastrointestinal problems that may accompany lupus are celiac disease, inflammatory bowel disease, eosinophilic enteritis, and pneumatosis cystoides intestinalis.
Reference:
Tian XP et al, “Gastrointestinal involvement in systemic lupus erythematosus: Insight into pathogenesis, diagnosis and treatment”, World Journal of Gastroenterology 2010 June; 16(24): 2971-77.
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.