Gastrointestinal Manifestations in SLE

Introduction

Systemic lupus erythematosus is a chronic inflammatory disease commonly found in women. The disease is strictly autoimmunity mediated; hence, the cause of its incidence is not quite certain. Many theories have been put forward to explain the occurrence of autoimmune diseases. The three primary factors that have been observed to cause autoimmune disorders include genetic or family history, environmental factors, and immunological factors. Lupus primarily affects women. However, men may also be predisposed to the disease. Out of every 10 people affected with SLE, 1 person identifies as a male. Lupus is said to affect a wide range of organ systems within the body, like the renal, cardiovascular, ocular, and neurological systems. This article focuses exclusively on how SLE affects the body's gastrointestinal system.

What Are the Gastrointestinal Manifestations of SLE?

The gastrointestinal symptoms are quite common in systemic lupus erythematosus patients. The majority of these symptoms are developed as a result of viral or bacterial infections. However, it is imperative to diagnose and treat these diseases effectively as a result of their life-threatening attributes. Digestive issues are a common complaint among 40 to 60 percent of SLE patients. The common symptoms reported include dysphagia, acute abdominal pain, nausea, and vomiting. Specific symptoms may be presented based on the type and severity of the disease. Vasculitis and thrombosis are recognized as the primary culprits for life-threatening diseases upon delayed or misdiagnosis.

Here are some of the most common gastrointestinal manifestations of SLE:

1. Diseases With Gastric Involvement:

• Peptic ulcer disease.

2. Diseases With Small Bowel and Colon Involvement:

• Intestinal pseudo-obstruction.

• Protein-losing enteropathy

3. Diseases With Hepatic Involvement:

• Autoimmune hepatitis.

• Lupus hepatitis.

4. Diseases With Pancreatic Involvement:

• Acute pancreatitis.

5. Other Diseases:

• Mesenteric vasculitis or ischemia.

• Peritonitis and ascites.

The remainder of the article addresses the symptoms of the aforementioned diseases one by one.

What Are the Symptoms of Peptic Ulcer Disease?

Peptic ulcer disease is characterized by the formation of painful ulcers and open sores, usually present on the inner lining of the stomach or small intestine. The inner lining of the stomach is generally protected by a thick layer of mucus. However, in some cases, the lining is damaged due to acidic juices secreted by the stomach. The two main causes reported for peptic ulcers are:

1. Administration of pain-relieving medications (NSAIDs).

2. Susceptibility to bacterial infections (H.Pylori infection).

The common myth suggesting stress and overly spiced food are the main reasons for the incidence of stomach ulcers is still believed by many. However, this does not hold.

Some of the common symptoms found in patients affected with peptic ulcer disease are:

• A burning sensation is felt in the upper or middle region of the stomach, especially at night.

• Episodic pain that tends to disappear upon consuming food or taking an antacid.

• Bloating and discomfort throughout the day.

• Heartburn is accompanied by the regurgitation of acidic components present in the stomach.

• Nausea and vomiting.

• Bleeding in the gastrointestinal tract results in the excretion of dark or black-colored stools.

• Severe weight loss and fatigue.

• Pain that is unbearable and requires immediate medical intervention.

What Are the Symptoms of Intestinal Pseudo-Obstruction?

Intestinal pseudo-obstruction is characterized by a physical obstruction in the bowel. However, there is no such obstruction present in reality. The paralysis of the bowels gives off a pseudo-obstructive effect. The cause behind the occurrence of this disease has not been discovered to date. However, the dysfunctional autonomic nervous system is said to be the main contributor to this disease. The autonomic nervous system plays a huge role in controlling involuntary muscular movements in the body (in this context, the peristalsis of the bowel).

The symptoms of intestinal pseudo-obstruction include:

• Abdominal distension accompanied by painful cramps.

• Loss of appetite.

• Significant weight loss.

• Bloating and gastric discomfort.

• Constipation or diarrhea experienced.

• Nausea and vomiting.

What Are the Symptoms of Protein-Losing Enteropathy?

Protein-losing enteropathy is described as a disorder characterized by excess loss of protein components from the body owing to an abnormal GI tract. The exact cause of this disease is not specified. This disorder is believed to be caused by multiple factors. The common symptoms of protein-losing enteropathy involve:

• Generalized edema or edema of the lower leg specifically.

• Accumulation of fluid in the abdominal cavity (ascites).

• Abdominal pain.

• Nausea and vomiting.

• Diarrhea.

What Are the Symptoms of Acute Pancreatitis?

Pancreatitis is nothing but the inflammation of the pancreas resulting in severe pain in the upper abdomen, sometimes also extending to the back.

It is an autoimmune condition wherein the digestive enzymes secreted by the pancreas -instead of digesting the food- work on the pancreas itself.

Acute pancreatitis is when the inflammation of the pancreas takes place all of a sudden for a very short period and resolves with proper medication and treatment.

The main cause of this type is gallstones. The patient commonly shows signs of:

• Severe pain in the upper abdomen (that may last for several days).

• Nausea and vomiting.

• Fever.

• Tender abdomen.

• Tachycardia (fast heartbeat).

Acute pancreatitis generally requires a hospital stay of several days during which the doctor monitors one’s overall health and makes sure to resolve complications arising from the condition. The doctor may also prescribe surgery as one of the treatment options in cases of recurrent episodes of pancreatitis due to gallstones. Gallbladder removal is a preferred choice in such cases.

What Are the Symptoms of Mesenteric Vasculitis?

Mesenteric vasculitis is also known by the name of Lupus mesenteric vasculitis (LMV), gastrointestinal vasculitis, and lupus enteritis. LMV is said to be one of the leading causes of acute abdominal pain in patients affected by SLE. The cause that triggers the occurrence of the disease is not yet known. However, several bacterial infections are said to play a role in its incidence.

The symptoms of mesenteric vasculitis include:

• Acute abdominal pain.

• Nausea and vomiting.

• Abdominal distension.

• Fever.

• Bowel sounds.

• Inflamed mesenteric vessels.

What Are the Symptoms of Ascites?

Ascites are characterized by the accumulation of abnormal fluid components in the peritoneal cavity of the body. It may present itself in both acute and chronic cases of SLE. The symptoms of ascites include:

• Abdominal distension.

• Abdominal pain.

• Abdominal discomfort.

• Diarrhea.

• Splenomegaly (enlargement of spleen).

• Fever.

• Hepatomegaly (enlargement of liver).

• Hypertension.

• Nausea and vomiting.

• Weight loss.

• Loss of appetite.

Conclusion

The gastrointestinal manifestations of SLE are reported in about 40 percent of patients affected by lupus. The majority of these conditions provide a good response upon treatment with corticosteroids and immunosuppressive agents. However, one must keep in mind to initiate prompt treatment upon diagnosis. Delayed diagnosis, along with delayed treatment, may result in severe life-threatening incidents that may otherwise be prevented.