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Gastrointestinal Manifestations of Systemic Lupus Erythematosus

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Gastrointestinal and Hepatic Manifestations of Rheumatic Diseases
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Abstract

Gastrointestinal (GI) symptoms are common in patients with systemic lupus erythematosus (SLE). SLE-related GI symptoms are distributed from the mouth to the anus. Lupus enteritis is one of the most common GI manifestations and defined as either vasculitis or inflammation of the small bowel, with supportive image and/or biopsy findings. Vasculitis also causes lupus colitis. Protein-losing enteropathy is one of the GI manifestations that shows hypoalbuminemia or increased fecal excretion of intravenous radiolabeled albumin. Radiological examination including computed tomography scan, histological analysis, and evaluation of infectious diseases are important to differentiate SLE-related GI symptoms from non-SLE conditions. Most cases of SLE-related GI symptoms respond well to a treatment with high doses of corticosteroids; however, some cases are recurrent and need surgical intervention because of life-threatening complications.

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References

  1. Dall’era M, Wofsy D. Clinical features of systemic lupus erythematosus. Kelly’s textbook of rheumatology. 9th ed. Amsterdam: Elsevier. p. 1283–303.

    Google Scholar 

  2. Tan EM, Cohen AS, Fries JF, et al. The 1982 revised classification of systemic lupus erythematosus. Arthritis Rheum. 1982;11:1271–7.

    Article  Google Scholar 

  3. Petri M, Orbal AM, Alarcon GS, et al. Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012;64:2677–86.

    Article  Google Scholar 

  4. Dubois EL, Tuffanelli DL. Clinical manifestations of systemic lupus erythematosus: computer analysis of 520 cases. JAMA. 1964;190:104–11.

    Article  CAS  Google Scholar 

  5. Liang HL, Socher SA, Larson MA, et al. Reliability and validity of six systems for the clinical assessment of disease activity in systemic lupus erythematosus. Arthritis Rheum. 1989;32:1107–8.

    Article  CAS  Google Scholar 

  6. Vitali C, Bencivelli W, Isenberg DA, et al. Disease activity in systemic lupus erythematosus: report of the consensus study group of the European workshop for rheumatology research. II. Identification of the variables indicative of disease activity and their use in the development of an activity score. Clin Exp Rheumatol. 1992;10:541–7.

    CAS  PubMed  Google Scholar 

  7. Gladman D, Ginzler E, Goldsmith C, et al. The development and initial validation of the systemic lupus international collaborating clinics/American college of rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum. 1996;39:363–9.

    Article  CAS  Google Scholar 

  8. Isenberg DA, Rahman A, Allen E, et al. BILAG 2004. Development and initial validation of an updated version of the British isles lupus assessment group’s disease activity index for patients with systemic lupus erythematosus. Rheumatology. 2005;44:902–6.

    Article  CAS  Google Scholar 

  9. Bombardier C, Gladman DD, Urowitz MB, et al. Derivation of the SLEDAI. A disease activity index for lupus patients. The committee on prognosis studies in SLE. Arthritis Rheum. 1992;35:630–40.

    Article  CAS  Google Scholar 

  10. Dotan I, Mayer L. Gastrointestinal: nonhepatic. Systemic lupus erythematosus. 5th ed. San Diego: Academic. p. 887–903.

    Google Scholar 

  11. Sultan SM, Ioannou Y, Isenberg DA. A review of gastrointestinal manifestations of systemic lupus erythematosus. Rheumatology. 1999;38:917–32.

    Article  CAS  Google Scholar 

  12. Kwok SK, Seo SH, Ju JH, et al. Lupus enteritis: clinical characteristics, risk factor for relapse and association with anti-endothelial cell antibody. Lupus. 2007;16:803–39.

    Article  CAS  Google Scholar 

  13. Buck AC, Serebro LH, Quinet RJ. Subacute abdominal pain requiring hospitalization in a systemic lupus erythematosus patient: a retrospective analysis and review of the literature. Lupus. 2001;10:491–5.

    Article  CAS  Google Scholar 

  14. Lee CK, Ahn MS, Lee EY, et al. Acute abdominal pain in systemic lupus erythematosus: focus of lupus enteritis (gastrointestinal vasculitis). Ann Rheum Dis. 2002;61:547–50.

    Article  Google Scholar 

  15. Byun JY, Ha HK, Yu SY, et al. CT features of systemic lupus erythematosus in patients with acute abdominal pain: emphasis on ischemic bowel disease. Radiology. 1999;211:203–9.

    Article  CAS  Google Scholar 

  16. Alves SC, Fasano S, Isenberg DA. Autoimmune gastrointestinal complications in patients with systemic lupus erythematosus: case series and literature review. Lupus. 2016;25:1509–19.

    Article  CAS  Google Scholar 

  17. Fessler BJ, Hoffman GS. Vasculitis. Systemic lupus erythematosus. 5th ed. San Diego: Academic. p. 833–45.

    Google Scholar 

  18. Estes D, Christian CL. The natural history of systemic lupus erythematosus by prospective analysis. Medicine (Baltimore). 1971;50:85–95.

    Article  CAS  Google Scholar 

  19. Ramos-Casals M, Nardi N, Lagrutta M, et al. Vasculitis in systemic lupus erythematosus: prevelence and clinical characteristics in 670 patients. Medicine (Baltimore). 2006;85:95–104.

    Article  Google Scholar 

  20. Pistiner M, Wallace DJ, Nessim AL, et al. Lupus erythematosus in the 1980s: a survey of 570 patients. Semin Arthritis Rheum. 1991;21:55–64.

    Article  CAS  Google Scholar 

  21. Zizic TM, Classen JN, Stevens MB. Acute abdominal complications of systemic lupus erythematosus and polyarteritis nodosa. Am J Med. 1982;73:525–31.

    Article  CAS  Google Scholar 

  22. Yuan S, YeY CD, et al. Lupus mesenteric vasculitis: clinical features and associated factors for the recurrence and prognosis of disease. Semin Arthritis Rheum. 2014;43:759–66.

    Article  CAS  Google Scholar 

  23. Janssens P, Arnaud L, Galicier L, et al. Lupus enteritis: from clinical findings to therapeutic management. Orphanet J Rare Dis. 2013;8:67.. http://www.ojrd.com/content/8/1/67

    Article  Google Scholar 

  24. Saito H, Kobayashi H, Watanabe K, et al. Usefulness of intraoperative esophagogastroduodenoscopy in a patient with lupus enteritis. Fukushima J Med Sci. 2008;54:38–42.

    Article  Google Scholar 

  25. Tsuchiya M, Okazaki I, Asakura H, et al. Radiographic and endoscopic features of colonic ulcers in systemic lupus erythematosus. Am J Gastroenterol. 1975;64:277–85.

    CAS  PubMed  Google Scholar 

  26. Nitzan O, Elias M, Saliba WR. Systemic lupus erythematosus and inflammatory bowel disease. Eur J Med. 2006;17:313–8.

    Article  CAS  Google Scholar 

  27. Nakase H, Herfarth H. Cytomegalovirus colitis, cytomegalovirus hepatitis and systemic cytomegalovirus infection: common features and differences. Inflamm Intest Dis. 2016;1:15–23.

    Article  Google Scholar 

  28. Miyahara S, Ito S, Soeda A, et al. Two cases of systemic lupus erythematosus complicated with colonic ulcers. Intern Med. 2005;44:1298–306.

    Article  Google Scholar 

  29. Maruyama A, Nagashima T, Iwamoto M, et al. Clinical characteristics of lupus enteritis in Japanese patients: the large intestine-dominant type has features of intestinal pseudo-obstruction. Lupus. 2018;27:1661–9.

    Article  CAS  Google Scholar 

  30. Isselbacher KJ, Podolsky DK. Protein-losing enteropathy. Harrison’s principals of internal medicine. 14th ed. New York: McGraw-Hill. p. 1631–3.

    Google Scholar 

  31. Divgi CR, Lisann NM, Yeh SDJ, et al. Technetium-99m albumin scintigraphy in the diagnosis of protein-losing enteropathy. J Nucl Med. 1986;27:1710–2.

    CAS  PubMed  Google Scholar 

  32. Chen Z, Li MT, Xu D, et al. Protein-losing enteropathy in systemic lupus erythematosus: 12 years experience from a Chinese academic center. PLoS One. 2014; https://doi.org/10.1371/journal.pone.0114684.

  33. Takagi S, Oshimi K, Sumiya M, et al. Protein-losing enteropathy in systemic lupus erythematosus. Am J Gastroenterol. 1983;78:152–4.

    CAS  PubMed  Google Scholar 

  34. Yoshida M, Miyata M, Saka M, et al. Protein-losing enteropathy exacerbated with the appearance of symptoms of systemic lupus erythematosus. Intern Med. 2001;40:449–53.

    Article  CAS  Google Scholar 

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Correspondence to Hiroko Kobayashi .

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Kobayashi, H. (2019). Gastrointestinal Manifestations of Systemic Lupus Erythematosus. In: Ohira, H., Migita, K. (eds) Gastrointestinal and Hepatic Manifestations of Rheumatic Diseases. Springer, Singapore. https://doi.org/10.1007/978-981-13-6524-9_6

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  • DOI: https://doi.org/10.1007/978-981-13-6524-9_6

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