Gastrointestinal: Nonhepatic

This chapter deals with the gastrointestinal (GI) ailments associated with systemic lupus erythematosus (SLE). In general, the major GI complications of SLE are less frequently seen than the skin rash, arthritis, and nephritis that commonly bring patients to clinical attention. However, in various series of patients with SLE, it is found that there are quite a number of listed signs and symptoms relating to the GI tract. The most serious GI complications of SLE are those associated with abdominal pain. Medication effects should always be considered first because they are probably more common than the serious GI complications. If a drug-related effect is ruled out, the appropriate laboratory evaluation should be initiated. Abdominal X-rays, searching for a paralytic ileus or free air secondary to perforation, should be followed by a diagnostic paracentesis, if warranted. Ascites should always be tapped to rule out the possibility of concomitant spontaneous bacterial peritonitis or the much rarer hemoperitoneum. CT is valuable in assessing both lupus-related and unrelated abdominal events. Quick surgical intervention is mandatory if there is evidence of perforation or gangrene. A major problem in recognizing GI tract disease as a complication of SLE is that much of the same GI pathology can be induced by the various medications used in SLE treatment. Another problem is that many of the symptoms relating to the GI tract are not as severe as the more pressing arthritis or nephritis and thus tend to be glossed over.