From the Guidelines
Gastrointestinal manifestations of systemic lupus erythematosus (SLE) flares can include dysphagia, abdominal pain, nausea, vomiting, diarrhea, and more severe complications like pancreatitis, mesenteric vasculitis, and protein-losing enteropathy, with dysmotility thought to be a contributing factor in patients complaining of dysphagia 1.
Key Manifestations
- Dysphagia is a common symptom, with up to 80% of patients complaining of it, similar to Sjogren’s syndrome, but with an unclear mechanism and variable findings on objective evaluation 1.
- Abdominal pain, nausea, vomiting, and diarrhea can also occur, with some patients experiencing more severe complications.
Diagnostic Considerations
- Upper endoscopy with biopsies and High-resolution esophageal manometry may be considered to evaluate esophageal involvement and dysmotility 1.
- The presence of autoimmune diseases such as SLE, Sjogren’s, and myositis can increase the risk of esophageal dysfunction and dysphagia 1.
Management
- Treatment of SLE flares typically involves corticosteroids, such as prednisone, and may also include immunosuppressants and steroid-sparing agents like hydroxychloroquine 1.
- Proton pump inhibitors may be added to prevent gastric complications from steroids.
- Patients should be monitored for signs of peritonitis, bowel perforation, or significant bleeding, which require immediate medical attention.
Pathophysiology
- SLE causes systemic inflammation affecting the blood vessels supplying the digestive tract, and immune complex deposition can directly damage the gut mucosa, leading to gastrointestinal manifestations 1.
- Proper hydration, a bland diet during acute symptoms, and avoiding NSAIDs that may worsen GI irritation are important supportive measures during flares.
From the Research
Gastrointestinal Manifestations of SLE Flare
The gastrointestinal (GI) manifestations of a systemic lupus erythematosus (SLE) flare are varied and can be severe. Some of the common GI symptoms include:
- Acute abdominal pain
- Nausea
- Vomiting
- Diarrhea
- Ascites
Specific GI Manifestations
Some specific GI manifestations of SLE flare include:
- Lupus enteritis: an uncommon manifestation of SLE, characterized by inflammation of the small intestine 2, 3
- Mesenteric vasculitis: inflammation of the blood vessels supplying the intestine, which can lead to severe complications such as bowel necrosis and perforation 4, 5
- Protein-losing enteropathy: a condition characterized by excessive loss of protein from the gut, leading to malnutrition and other complications 4, 3
- Intestinal pseudo-obstruction: a condition characterized by impaired motility of the intestine, leading to severe abdominal pain and other symptoms 3
Diagnosis and Treatment
Diagnosis of GI manifestations of SLE flare can be challenging, and requires a high index of suspicion and the use of various diagnostic modalities such as:
- CT scan of the abdomen: can help diagnose lupus enteritis and other GI manifestations 2, 5, 3
- Upper endoscopy: can help diagnose inflammation and other abnormalities in the upper GI tract 3
- Laboratory tests: can help assess disease activity and diagnose other complications such as infection or thrombosis 4, 3 Treatment of GI manifestations of SLE flare typically involves the use of:
- Corticosteroids: can help reduce inflammation and suppress the immune system 2, 4, 3
- Immunosuppressants: can help reduce disease activity and prevent complications 4, 3
- Supportive care: can help manage symptoms and prevent complications such as malnutrition and dehydration 3, 6