Can lupus affect stomach?

Quick Answer

Yes, lupus can affect the stomach and cause a range of gastrointestinal symptoms. About 40-45% of people with lupus experience GI problems, including acid reflux, abdominal pain, nausea, vomiting, and ulcers. Lupus can cause inflammation in the stomach lining as well as other parts of the GI tract. Treatment focuses on managing symptoms and may include antacids, H2 blockers, PPIs, steroids, immunosuppressants, and diet changes.

What is lupus?

Lupus is an autoimmune disease where the immune system attacks the body’s own healthy tissue and organs. It causes inflammation throughout the body and can affect many different systems, including the joints, skin, kidneys, heart, lungs, blood vessels, and brain. There are several types of lupus:

• Systemic lupus erythematosus (SLE) – Most common type that can affect any part of the body
• Cutaneous lupus – Affects the skin
• Drug-induced lupus – Caused by certain medications
• Neonatal lupus – Affects newborns of women with SLE antibodies

Around 1.5 million Americans have some form of lupus, with SLE being the most prevalent. It is more common in women, particularly of childbearing age, and is also more common in Hispanic, Asian, and Black populations. The exact causes are unknown but likely involve a combination of genetic, environmental, and hormonal factors. There is no cure, but symptoms can be managed with medications and lifestyle changes.

How can lupus affect the stomach?

Lupus can cause a range of gastrointestinal problems, collectively referred to as lupus gastroenteritis or lupus enteritis. Estimates suggest 40-45% of people with lupus will experience some type of GI issue. Problems can include:

• Gastritis – Inflammation of the stomach lining, causing nausea, vomiting, abdominal pain, bloating, loss of appetite.
• Esophagitis – Inflammation of the esophagus, causing heartburn, acid reflux, swallowing difficulties.
• Pancreatitis – Inflammation of the pancreas, causing severe abdominal pain, nausea, vomiting.
• Hepatitis – Inflammation of the liver, which can lead to jaundice, fatigue, nausea.
• Enteritis and colitis – Inflammation of the small and large intestines, causing diarrhea, abdominal pain.
• Protein-losing enteropathy – Disorder where proteins are abnormally lost through the GI tract.
• Malabsorption – Impaired ability to absorb nutrients, causing diarrhea, weight loss, bloating.
• Bowel perforation – Rare complication where holes form in the intestines.
• Ulcers – Painful sores in the stomach lining or intestines.

These conditions are caused by inflammation damaging the mucosal lining of the GI tract. Normally, the lining acts as a protective barrier, but with lupus the immune system attacks these tissues. It is also thought that decreased blood flow to the GI tract as a result of lupus contributes to injury of the mucosa.

Some of the most common symptoms of lupus gastroenteritis include:

• Heartburn
• Nausea
• Vomiting
• Abdominal pain
• Bloating
• Diarrhea or constipation
• Blood in stool
• Unexplained weight loss
• Loss of appetite

Diagnosing lupus gastroenteritis

If lupus-related stomach problems are suspected, your doctor will typically start with a physical exam, medical history, and blood tests.

• Physical exam – Checks for signs of GI distress like abdominal tenderness.
• Medical history – Questions about symptoms and existing lupus diagnosis.
• Blood tests – May show anemia, elevated inflammatory markers, or antibodies related to lupus.

If lab results and exam suggest GI involvement, the following tests may be used to confirm the diagnosis and evaluate the extent of damage:

• Stool tests – Check for blood, fat, bacterial overgrowth, or lack of enzymes/proteins.
• Upper endoscopy – Camera to visually examine the esophagus and stomach lining.
• Colonoscopy – Camera to examine the large intestines.
• Biopsy – Taking a tissue sample to examine under a microscope.
• CT scan – Cross-sectional X-ray images of the abdomen.
• Barium X-ray – Swallowing a chalky liquid to outline the GI tract on X-rays.

Looking for damage, ulcers, inflammation, and abnormal blood vessels can help confirm lupus is affecting the GI system.

Can stomach problems be the first symptom of lupus?

For some patients, gastrointestinal issues may be one of the first signs of lupus. However, GI involvement is more likely to arise later in the disease course after an initial lupus diagnosis.

According to one study, around 3% of lupus patients had GI symptoms present before any other manifestations of lupus. Of these patients, the most common initial symptoms were:

• Abdominal pain (54%)
• Nausea/vomiting (46%)
• Diarrhea (23%)
• Constipation (15%)
• GI bleeding (8%)

These GI problems led doctors to identify the underlying lupus diagnosis in patients who had not yet presented with more typical symptoms like joint pain, rashes, and fatigue.

However, experts emphasize that GI symptoms alone are not enough to diagnose lupus. Further testing would be needed to confirm systemic autoimmunity and rule out other potential causes. But new onset digestive issues should prompt consideration of a possible lupus diagnosis in at-risk individuals, even if no other signs are present yet.

Associated complications

If left untreated, lupus involving the gastrointestinal tract can lead to further complications such as:

• Ulcers – Can cause internal bleeding in the stomach or intestines. Ulcers are present in around 50% of lupus patients with GI problems.
• Bleeding – Can cause anemia from losing blood, or be life-threatening if severe.
• Bowel perforation – Hole in the intestine requiring emergency surgery.
• Obstruction – Blockage of the intestines requiring hospitalization.
• Malnutrition – From poor absorption of nutrients.
• Dehydration – From severe vomiting or diarrhea.
• Electrolyte imbalances – Having abnormal sodium and potassium levels.
• Sepsis – A dangerous blood infection.

Catching lupus gastroenteritis early allows these potential complications to be prevented or managed appropriately. Routine screening can help detect problems before they progress.

Risk factors

Certain lupus patients seem to be at increased risk of developing gastrointestinal problems. Risk factors include:

• Positive anti-SSA antibodies – Present in 70% of lupus patients with GI disease vs. 30% without.
• Disease duration – GI issues more likely after having lupus longer term.
• High disease activity – Worse GI symptoms during lupus flares.
• Kidney involvement – Lupus nephritis patients at 2-3x higher risk.
• Use of corticosteroids – Frequent with active lupus but also increase GI bleeding risk.
• Previous GI surgery – Can increase risk of poor healing due to lupus.
• Smoking
• Excess alcohol use

Understanding these risk factors allows physicians to better screen, monitor, and manage high-risk lupus patients for potential GI involvement.

Treatment

Treatment of lupus gastroenteritis focuses on controlling symptoms and preventing complications via a few key approaches:

1. Medications

Common medications used include:

• Antacids – Help neutralize stomach acid and provide symptom relief for heartburn, reflux, and dyspepsia.
• H2 blockers – Reduce acid production, used for heartburn and reflux symptoms. Examples are famotidine, cimetidine, and ranitidine.
• Proton pump inhibitors (PPIs) – More potent inhibitors of acid production used for more severe symptoms. Omeprazole and esomeprazole are examples.
• Steroids – Help control inflammation in the GI tract mucosa. Given orally or intravenously.
• Immunosuppressants – Medications used to treat severe lupus like azathioprine, methotrexate, and mycophenolate mofetil are also used for GI involvement.

These medications aim to reduce acid secretion, pain, and direct immune attack on the GI system.

2. Diet changes

Diet tips to minimize GI lupus symptoms include:

• Avoiding foods that trigger reflux – High fat, spicy, acidic, coffee, alcohol, chocolate, etc.
• Eating smaller, more frequent meals
• Staying hydrated
• Limiting fiber during flares when diarrhea present
• Increasing fiber when constipated
• Implementing food diaries to identify problematic foods to avoid

A dietician can provide guidance on the best diet to minimize GI symptoms.

3. Surgery

Surgery may be necessary in some cases for:

• Bowel obstruction or perforation
• Severe ulcer disease
• Significant GI bleeding
• Malabsorption and weight loss not responding to other therapies

However, surgery carries higher risks of complications like poor wound healing in lupus patients, so it is typically a last resort option when other treatments fail. Careful post-surgical monitoring is essential.

4. Monitoring and screening

Ongoing screening and care from a gastroenterologist experienced in managing lupus is recommended. This allows early detection of any new GI issues. Monitoring may include:

• Routine blood tests to check for anemia and malnutrition
• Periodic stool tests to check for occult blood
• Regular endoscopies in higher risk patients to check for ulcers
• Reporting any new GI symptoms promptly to the healthcare team

Early detection allows faster treatment and prevention of complications. Screening frequency is tailored to the individual based on symptoms and risk profile.

Prognosis and outlook

With proper treatment, many patients with lupus gastroenteritis can achieve a reduction in symptoms and complication risk. Mild manifestations can often be managed effectively long-term. However, GI involvement is linked to an overall poorer prognosis in lupus patients.

Lupus patients with moderate to severe GI disease have higher rates of:

• Disease flares
• Organ damage accrual
• Need for immunosuppressants
• Hospitalizations

One study found a 13-year survival rate of just 56% in patients with severe GI lupus compared to 89% survival in lupus patients without GI involvement. Despite advances in treatment, the mortality rate for patients with significant lupus gastroenteritis remains higher than lupus patients without it.

Close monitoring and follow-up care is key to detecting and promptly managing any disease activity in the GI tract. Patients should remain vigilant about symptoms and communicate regularly with their healthcare team. While GI issues can complicate lupus, the outlook can be improved with proper treatment and management.

The takeaway

It is fairly common for lupus to involve the gastrointestinal tract and cause symptoms like heartburn, nausea, pain, and ulcers. This is referred to as lupus gastroenteritis or lupus enteritis. Around 40-45% of lupus patients experience GI problems due to inflammation damaging the stomach and intestinal lining. While GI issues are rarely the very first manifestation, they can arise at any point. Treatment focuses on controlling inflammation and symptoms with medications, diet changes, surgery if necessary, and vigilant monitoring. Close follow up care is essential given the increased risks of complications, flares, and mortality in lupus patients with gastrointestinal involvement. With proper management, many patients achieve a good reduction in their GI symptoms. However, lupus involving the GI tract does negatively impact the overall prognosis. Patients should be aware of the possibility of GI disease and stay on top of any related symptoms. Prompt reporting of issues allows early intervention to improve outcomes.

Frequently asked questions

Can lupus cause gastroparesis?

Gastroparesis, delayed emptying of the stomach, is a potential complication of lupus. Lupus can cause damage to the vagus nerve, which controls stomach motility, leading to this condition. Symptoms include nausea, vomiting undigested food, bloating, and weight loss. It’s diagnosed via gastric emptying tests and managed with medications, diet changes, and sometimes surgery.

Does lupus always show up in blood work?

No, some lupus patients have negative blood work despite having active symptoms. About 10-15% of people diagnosed with lupus have normal routine blood test results. However, other specific antibody tests and organ function tests can help detect lupus. Blood work alone should not rule out a lupus diagnosis.

Can lupus be diagnosed with a biopsy?

Sometimes a biopsy of involved tissue like the kidney, skin, or gastrointestinal tract may be done to help confirm a lupus diagnosis. Finding typical immune complex deposits and inflammation patterns on biopsy can support systemic lupus erythematosus as the underlying cause. However, biopsy results are not definitive for lupus and other testing is needed.

Does lupus qualify you for disability benefits?

If lupus impacts your ability to work and perform daily activities, you may qualify for Social Security Disability benefits under the impairments listing for systemic lupus erythematosus or immune system disorders. Approval is based on medical history, test results, symptoms, and response to treatment. Many lupus disability claims are approved, especially if major organs are affected.

Can men get lupus?

Yes, although lupus is much more common in women, men can develop this autoimmune condition as well. About 1 in 10 diagnosed cases of lupus occurs in males. Symptoms and treatment are similar in men and women. However, some research suggests hormonal differences may impact the disease course and severity in male lupus patients.

Conclusion

In summary, lupus has the potential to significantly impact the gastrointestinal system and cause troubling digestive symptoms. This is known as lupus gastroenteritis. Inflammation in the lining of the stomach and intestines occurs in 40-45% of lupus patients, leading to issues like nausea, pain, ulcers, and bleeding. Mild cases can often be managed well, but moderate to severe GI involvement negatively impacts lupus prognosis and survival rates. Treatment relies on controlling inflammation and symptoms with medications, diet changes, surgery if needed, and vigilant monitoring and screening. While GI problems can complicate lupus, outcomes can be improved with prompt recognition and management of any related symptoms and flare-ups. Patients should stay attuned to their bodies and speak with their doctors about optimal prevention and treatment strategies. With proper care, gastrointestinal manifestations of lupus can typically be improved.