Major gastrointestinal manifestations in lupus patients in Asia: lupus enteritis, intestinal pseudo-obstruction, and protein-losing gastroenteropathy

Abstract

Gastrointestinal (GI) symptoms are common in patients with systemic lupus erythematosus (SLE) and may be due to the disease itself, side-effects of medications, or non-SLE causes. However, GI manifestations of lupus attract far less attention than the other major organ involvements, are infrequently reviewed and rarely documented in published lupus databases or cohort studies including those from countries in Asia. According to three reports from two countries in Asia, the cumulative prevalence of SLE GI manifestations range from 3.8% to 18%. In this review, we focus on three major GI manifestations in patients from Asian countries: lupus enteritis, intestinal pseudo-obstruction, and protein-losing gastroenteropathy, for which early recognition improves outcome and reduces morbidity and mortality.

Chronic Diarrhea as the Presenting Complaint of Systemic Lupus Erythematosus in a Man

“…Among Indian males with SLE, GI manifestations occur at an incidence of 15% (4). The Asian population has a higher prevalence (18%) of GI manifestations compared to populations on other continents (2). Hepatosplenomegaly is the only GI manifestation that is more common in men (7) and that has been observed in the Israeli population.…”

“…In a study of the largest cohort of male SLE patients, no GI manifestations or psychosis were observed at the onset of the disease (8). Mucosal symptoms, including ulcers, anorexia and abdominal pain, are common, while diarrhea, fecal incontinence, perforation and hemorrhage are rare (1,2,9). Other very uncommon abdominal manifestations in SLE patients include protein-losing enteropathy (PLE), lupus enteritis, eosinophilic enteritis and intestinal pseudo-obstruction (IPO) (3).…”

“…The gastrointestinal manifestations of SLE can involve any part of the gastrointestinal (GI) tract, with incidences ranging from 1.3% to 27.5% (1)(2)(3). Diarrhea occurring in patients with SLE generally results from parasitic or bacterial intestinal infections and can be caused by chronic pancreatitis or drugs such as azathioprine (4,5).…”

Systemic lupus erythematosus with intestinal perforation: A case report

“…Lupus enteritis is steroid responsive and typically has an excellent overall prognosis. If not treated correctly, SLE may develop to intestinal necrosis and perforation of the intestinal tract, which is among the most severe complications of SLE (4,5). The present study reported a case of SLE with intestinal perforation, which required surgical intervention.…”

A case with hydroureteronephrosis accompanied by Lupus Mesenteric Vasculitis

“…IPO may also co-exist with hydroureteronephrosis and is diagnosed on the basis of clinical examination and imaging studies. Direct x-rays may display multiple air-fluid levels as well as enlarged small intestinal segments, while CT may also show increased intestinal wall thickness [7]. Pathophysiological mechanisms underlying the development of IPO in SLE have not been clearly elucidated, although proposed mechanisms include development of visceral smooth muscle injury and dysmotility subsequent to immune-complex mediated vasculitis.…”