Lupus and Gastrointestinal System

Dr. Adhya Karki, MD, Internal Medicine; DM, Gastroenterology

Lupus is a multi-organ, auto-immune disease that affects the body’s immune system and almost all other systems in the body. Lupus can specifically affect the gastrointestinal (GI) system. The immune system, instead of protecting the body from foreign invaders, such as bacteria, viruses, and other pathogens, attacks healthy body tissue. Lupus usually affects the joints and skin, but it can also cause health issues in the kidneys, heart, lungs, blood, or even the brain. Lupus can also affect the GI tract in the digestive system. Lupus can also damage cells, joints, and organs to cause health issues

There are several types of lupus. Systemic lupus erythematosus (SLE) is the most common form of lupus, which can affect many body organs. Another form of lupus is cutaneous lupus, which affects only the skin, drug-induced lupus, and neonatal lupus.

Lupus can affect any organ of the GI tract, including the liver, pancreas, and gallbladder. Lupus can slow the digestive process, and this can cause a wide variety of GI issues. Digestive problems may be the direct result of an attack by the immune system or from medications to treat lupus. These digestive difficulties include nausea, vomiting, diarrhea, or constipation.

Lupus Nepal explores how lupus affects the gastrointestinal system through Dr. Adhya Karki, MD (Internal Medicine), DM (Gastroenterology), KIST Teaching Hospital and Frontline Hospital.

How does lupus affect the gastrointestinal (GI) system?
GI symptoms are very common in patients with lupus. About 40-50 % of patients experience GI symptoms during their lifetime. These can be nonspecific and can result from the disease itself, from the medications used to treat lupus, or concomitant infection. Most commonly encountered symptoms are nausea, vomiting, loss of appetite, abdominal bloating, post-meal abdominal discomfort, early satiety, diarrhea, mouth ulcers, difficulty in swallowing, pain while swallowing, and symptoms of reflux or regurgitation. In severe cases, patients may present with vomiting of blood or passage of black colored stool, severe diarrhea, and generalized body swelling due to protein loss through the intestine.

Some danger signs to be looked for are weight loss, bleeding from mouth or anus or passage of black colored stool, severe diarrhea, severe upper abdominal pain not relieved with medication lasting for longer duration, intractable vomiting, and abdominal distension with no passage of stool or flatus.

Your experience with lupus patients?
More than half of the patients living with lupus have GI manifestations with varied symptoms. Due to the chronicity of the disease and early life presentation, most patients suffer a lot. However, with precaution and proper awareness provided to them regarding the likely symptoms, most patients have relief in their symptoms with medication. Due to the nonspecific manifestation, patients may not present to the gastroenterologist very often. It is the fighting spirit of lupus warriors that helps them surpass all the difficulties.

Advice to lupus patients
Since the GI symptoms may be non-specific, awareness amongst patients regarding the manifestations and the danger signs must be provided at the time of diagnosis. They should know when to see a gastroenterologist. Diet plays an important role in maintaining overall physical health of patients. It is better to avoid taking sugary, acidic food, red meat, and food causing gas formation like beans, cauliflower, broccoli, alcohol, and smoking.
It is always wise to keep yourself hydrated and take food that is easy to digest. Food that are considered anti-inflammatory like dry fruits, avocado, green leafy vegetables, lean protein like fish, carrot, cucumber, and whole food is advisable. Some form of physical activity to keep yourself physically fit is recommended. Any form of recreation to relieve stress should be considered in order to avoid stress, which may be one of the triggering factors for flare-up of symptoms. Keeping a positive attitude towards life without exertion is the key to fight any illness, including lupus.

Steps to help protect your digestive system
While many digestive problems need medical treatment, making lifestyle changes may prevent or ease some symptoms.
• Get enough sleep—and avoid eating right before bedtime.
• Protect yourself from infections—depending on which digestive problems you have, your rheumatologist can suggest other changes to help you feel better.
• Drink plenty of water, especially when you’re on medication.
• Eat a healthy diet and be physically active.
• If you drink alcohol, drink only in moderation.
• Take steps to manage your everyday stress.

Since lupus can cause a lot of different digestive problems, there are many different medicines that can be used during treatment. Your gastroenterologist can work with your rheumatologist to find a treatment plan that works for you.

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