In what ways can the gastrointestinal tract be involved in SLE?
• Esophageal dysmotility: Usually involves upper third of esophagus in patients with SLE myositis, common in overlap syndromes.
• Pancreatitis: Usually due to gallstones, alcohol, or hypertriglyceridemia. Can be due to medications (azathioprine [AZA]). If due to SLE, the patient will have diffusely active disease.
• Serositis: Only occurs in patients with active systemic disease. Rare to get frank ascites. Need to R/O infection.
• Mesenteric vasculitis: Likely associated with active disease. Will see bowel wall edema and sometimes fat-stranding on computed tomography of abdomen.
• Hepatitis: usually as a result of medications or other non-lupus cause. If due to lupus, patients do not have anti-smooth muscle or anti-liver-kidney microsome antibodies.
• Intestinal pseudo-obstruction: Rare manifestation with obstruction picture but without identifiable mechanical or obstructive causes. Can present with abdominal pain, vomiting, diarrhea and/or constipation, abdominal distension, and weight loss along with an x-ray suggestive of obstruction.
• Protein-losing enteropathy (PLE): Consider in patients with severely low albumin but no proteinuria. Most patients have chronic diarrhea and edema from low serum proteins. Diagnosis made by measuring fecal alpha-1 antitryspin or transferrin. Stool should not have transferrin unless there is a PLE.
Pearl : A gastrointestinal manifestation (serositis, vasculitis, and pancreatitis) is unlikely to be due to SLE unless the patient has evidence of active SLE in other organs and abnormal serologies.