Nonhepatic gastrointestinal manifestations of systemic lupus erythematosus

When considering the "systemic" nature of lupus erythematosus, the gastrointestinal (GI) tract tends to be overlooked. It has been illustrated in the study that the GI tract can overshadow many of the other aspects of systemic lupus erythematosus (SLE). The most serious GI complications of SLE are those associated with abdominal pain. Medication effects should always be considered first, since they are probably more common than the serious GI complications. If a drug-related effect is ruled out, the appropriate laboratory evaluation (including CBC, ESR, serum amylase and lipase levels, serous lactate urinalysis and stool guaiac in addition to disease activity-related serologies) should be initiated. Abdominal X rays, looking 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. Computed tomography is valuable in assessing both lupus-related as well as unrelated abdominal events, as it should be kept in mind that SLE patients presenting with abdominal pain syndromes may have conventional gastrointestinal illnesses. Quick surgical intervention is mandatory if there is evidence of perforation or gangrene, as it appears that earlier surgery, even in sicker patients, yields a better prognosis. If paracentesis and X rays are negative, then these patients fall into Dubois' category of potentially reversible ischemia and should be treated with increasing doses of steroids. These patients should respond rapidly.