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How Lupus Affects the Gastrointestinal System  

Lupus is a condition affecting the body’s immune system, but it can affect nearly all of the other systems in the body. Specifically, lupus can affect the gastrointestinal (GI) system.

The immune system protects the body from foreign invaders, such as bacteria, viruses, and other pathogens. Lupus causes the immune system to attack healthy body tissue instead. 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.

In many cases, lupus causes inflammation that disrupts how body cells, tissues, and organs function. The condition can also damage cells, joints, and organs to cause health problems.

There are several types of lupus and lupus-like conditions. Systemic lupus erythematosus (SLE) is the most common form of lupus; it can affect many body systems. Another form of lupus, cutaneous lupus affects only the skin. Drug-induced lupus and neonatal lupus are lupus-like conditions.

The gastrointestinal tract is a series of hollow organs joined together to form a long, twisting tube that extends from the mouth to the anus. Powerful muscles along the digestive tract control swallowing, the movement of food through the GI tract, and bowel movements. The hollow organs include the mouth, esophagus, stomach, small intestine, large intestine, and anus. Other solid organs of the digestive system, including the liver, pancreas, and gallbladder, also contribute to digestion. Each performs a different function.

Lupus can affect any organ of the GI tract, including the liver, pancreas, and gallbladder. The effects of lupus may be a direct result of damage done by the immune system on healthy body tissues, or they may be the indirect result of the medications a person takes for lupus.

How Lupus Affects Various Organs in the Digestive System

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.

Esophageal disorders in lupus

The esophagus is the muscular tube that joins the throat to the stomach. Food moves from the mouth, down through the esophagus and into the stomach, where strong stomach acids break down the food for digestion. Sometimes the stomach acid can move backward, or reflux, up into the esophagus in a condition known as heartburn or gastroesophageal reflux disease (GERD). Once there, the stomach acid can damage the esophagus.

Acid reflux can irritate the lining of the esophagus; this irritation can cause difficulty swallowing, a condition known as dysphasia. Between 1.5 and 13 percent of people with SLE experience dysphasia, and up to half may have heartburn.

Peptic ulcers

Peptic ulcers are sores that develop on the inside lining of the stomach. They can also appear on the upper portion of the small intestine, where it connects to the stomach. Peptic ulcers can cause indigestion, also known as dyspepsia. About 4 to 21 percent of people with SLE experience dyspepsia, but it could be because most people with SLE take non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation associated with lupus.

Ulcerative colitis and Crohn’s disease

Ulcerative colitis and Crohn’s disease are two types of inflammatory bowel disease (IBD). Ulcerative colitis causes ulcers (sores) to develop in the lining of the rectum and colon. Crohn’s disease causes inflammation of the GI tract. Both Crohn’s disease and ulcerative colitis can cause bloody diarrhea and abdominal pain, but the two are different diseases.

Peritonitis and ascites

The peritoneum is a thin membrane that covers the internal organs and lines the cavity of the abdomen. Peritonitis is a condition characterized by inflammation of the peritoneum. Peritonitis often develops as the result of an infection, but lupus may also cause inflammation of the peritoneum.

Inflammation from lupus can also cause fluid to accumulate in the abdominal cavity. This condition, known as ascites, can cause severe abdominal pain, tenderness of the belly, nausea, vomiting, fever, and the lack of bowel movements. Ascites may also be the result of infection, liver disease, pancreatitis, cancer, or other conditions.

Pancreatitis

The pancreas makes enzymes that break down sugars, fats, and starches during digestion. The pancreas also makes hormones, which are chemical messengers that cause changes throughout the body.

Lupus can cause inflammation of the pancreas in a condition known as pancreatitis. Medications for lupus, such as corticosteroids, immunosuppressants, and diuretics, can also cause pancreatitis.

Liver complications

Liver complications

The liver is the largest internal organ of the body, and it is one of the most important. This organ filters blood coming from the digestive tract before passing the blood to the rest of the body. The organ also regulates most of the chemicals in the blood, metabolizes medications, clears alcohol and other toxins from the blood, and secretes bile that aids in digestion.

Lupus can cause inflammation in the liver, in a condition known as hepatic vasculitis, which can cause the formation of blood clots in the blood vessels serving the liver. Reduced blood flow, ascites, and other conditions can cause enlargement of the liver. Symptoms of an enlarged liver include abdominal pain and jaundice, which is yellowing of the skin and eyes. An inflamed or enlarged liver leaks higher-than-normal amounts of certain chemicals, known as enzymes. High enzyme levels, jaundice, ascites, and inflammation of the liver may be the result of lupus or medications for the treatment of lupus.

Autoimmune hepatitis

Autoimmune hepatitis is a condition in which the immune system attacks the liver. Autoimmune hepatitis is a rare condition that affects females four times more often as it does males.

In autoimmune hepatitis, the immune system attacks the liver, which causes inflammation of that organ. There are two types of autoimmune hepatitis. Type 1 autoimmune hepatitis is the most common form of the disease in North America; it is more common in adults than in children. About half of those with type 1 have other autoimmune disorders, such as rheumatoid arthritis, celiac disease, or ulcerative colitis.

Type 2 is more common in children; this type of autoimmune hepatitis can cause severe disease. Those with type 2 may also have other immune disorders.

Symptoms of autoimmune hepatitis include:

  • Fatigue
  • Abdominal discomfort
  • An enlarged liver
  • Jaundice
  • Abnormal blood vessels on the skin, known as spider angiomas
  • Joint pains
  • Skin rashes
  • Loss of menstrual periods

For more information on how lupus affects the gastrointestinal system, speak with a doctor or gastroenterologist. Early detection and treatment of GI problems can reduce unpleasant symptoms or long-lasting damage to the digestive tract.

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