The Gastrointestinal System
We all know that lupus can devour almost any part of the body – which means, sadly, the gastrointestinal system is not exempt from its calculating clutch. People with lupus often experience problems of the gastrointestinal (GI) system, and can even have issues with the surrounding organs, including the liver, gallbladder, bile ducts and pancreas. Sometimes, the complications may not even stem from lupus; rather, the culprit could be the medications one is taking to help fight lupus. How’s that for a fun game of Catch 22!! (insert sarcastic tone here).
So, what exactly does your GI system do? Simply put, this system is your body’s doorway for bringing in, breaking down, and disposing of everything. Anything you eat or drink goes from your mouth to your throat, through your stomach to your intestines, to your colon, and ends up at your rectum or urinary tract system.
Your GI system is divided into two parts: upper and lower. Your upper GI tract is made up of your buccal cavity, pharynx, esophagus, stomach and duodenum. Your lower GI tract is made up of the small intestine (duodenum, jejunum and ileum) and the large intestine (cecum, colon, rectum and anal canal).
With all these parts working together to digest and expel everything from your morning chia-seed muffin to your double-chocolate cake dessert, it is not surprising that there will be issues from time to time. Throw in an autoimmune inflammatory disease like lupus and viola! You may have a recipe for one of the conditions listed below. Back to top
Stomach acid can back up into your esophagus (a muscular tube which runs behind the trachea that connects your throat to your stomach) and cause discomfort when lupus causes inflammation. This backward flow of acid, called reflux, is experienced by virtually everyone from time to time. But, when it becomes a persistent issue that causes pain and discomfort, it is known as gastroesophageal reflux disease (GERD). Causes for GERD include: hiatal hernias, weak sphincter muscles or weak contractions in your esophagus. Treatment for GERD includes over-the-counter medications that control acid (Maalox®, Mylanta®, Rolaids® and Tums® may provide quick relief). Other medications called H-2 receptor blockers (Zantac®, Pepcid AC®, Tagamet HB®) may work better in the long run. Lastly, if medications do not provide relief, sometimes surgery to reinforce the lower esophageal muscles is needed. Back to top
Can’t eat anything these days without spending the remainder of the night in the restroom? Well, you are not alone. Digestive problems are extremely common with lupus. Symptoms such as: vomiting (or feeling like you are going to vomit), diarrhea, and constipation all make the lupus “digestive woes” list. Sadly, many of the medications that are prescribed for lupus (such as steroidal and NSAIDs) can be the cause of your woes. However, there are occasions where digestive issues occur because the muscles are not moving waste through your intestines properly. Irritable Bowl Syndrome or (IBS), is a disorder that affects the colon and causes cramping, abdominal pain, bloating, gas, diarrhea and constipation. IBS is considered a chronic condition that will need to be managed long term, and is believed to possibly be related to irregularities in your nervous system. In mild cases, IBS can be controlled by lifestyle changes including: exercising, avoiding trigger foods, drinking plenty of water and getting proper sleep. Back to top
Crohn’s & Colitis
Crohn’s disease and ulcerative colitis and are two forms of inflammatory bowel disease that affect the colon. Crohn’s is an ongoing disease associated when inflammation of the GI tract that can cause bloody diarrhea and abdominal pain. It can be tricky to tell the difference between the two because colitis can also cause similar symptoms. Ulcerative colitis differs from Crohn’s disease mainly because it only affects the innermost lining of the large intestine and the inflammation (or ulcers) is usually only found in the rectum and parts of the colon. People with lupus may sometimes develop ulcerative colitis at some point of the duration of their illness, but it is rare that someone will have both lupus and Crohn’s disease. Treatments for Crohn’s disease include: medications (antibiotics, aminosalicylates, corticosteriods, immunomodulators and biologics) and surgery (strictureplasty, resection and protocolectomy or colectomy). Treatments for ulcerative colitis include: medications (aminosalicylates, corticosteriods, immunomodulators and biologics) and 25-30% of people may need surgery (colectomy) to have an internal or external waste bag attached to their abdominal wall. Back to top
Certain medications (like NSAIDs) may increase the risk of developing ulcers in the stomach lining and duodenum. Also, certain bacteria (like Helicobacter pylori) may also cause ulcers and can be more common in people with lupus due to generally having a higher risk for infection. Treatment for peptic ulcers include: medications like Prevacid®, Prilosec®, and Cytotec®. Back to top
Pancreatitis is inflammation of the pancreas. Sometimes this can be caused by lupus, sometimes it can be caused by a condition called vasculitis, and sometimes it can be caused by certain medications you may be taking. Corticosteroids, immunosuppressants, and diuretics have been known to occasionally cause pancreatitis. Ironically, treatment for pancreatic vasculitis is corticosteroids. However, acute pancreatitis caused by corticosteroids or other issues is treated by withdrawing the steroid medication, administering pain medications, antibiotics, and hydration. People are usually told to stop eating and drinking for a period of (a few days to several weeks) to allow the pancreas to heal. Back to top
Peritonitis and Ascites
Inflammation of the peritoneum (the thin lining of your abdomen) is diagnosed as peritonitis. This is usually caused by some sort infection. Sometimes people suffering from lupus can also experience peritonitis because of fluids that build-up in the abdominal cavity (ascites). The symptoms you may experience from peritonitis or ascites can include severe abdominal pain, tenderness when your belly is touched, nausea and vomiting, fever, and/or lack of bowel movements. Proper diagnosis is crucial because many things can cause ascites and its symptoms (belly tenderness, nausea, vomiting, fever, lack of bowel movements) and can mimic other disorders, so your physician may take a sample of the fluid from your belly to confirm the diagnosis and determine proper treatment. Back to top
The liver is one of the most important (and the largest) organs inside your body and it has many responsibilities. Your liver makes bile, changes food into energy and cleans poisons from your blood. Lupus inflammation in the liver can cause many issues including hepatic vasculitis and blood clots. Your liver may be swollen due to ascites or heart issues as well. Lupus patients can experience increased enzyme levels which could be caused by disease activity, taking NSAIDs or acetaminophen. This can lead to a condition called jaundice which is a yellowing of the skin and whites of the eyes.
Another complication when the immune system attacks the liver is called autoimmune hepatitis. Autoimmune hepatitis is classified into two categories: type 1 or 2. Type 1 is the most common and can occur at any age. 50% of individuals with type 1 have another autoimmune disease, like lupus, Sjögren’s syndrome, type 1 diabetes, or ulcerative colitis. Type 2 is less common, and typically only affects girls between the ages 2 to 14. Symptoms of autoimmune hepatitis include: fatigue, enlarged liver, jaundice, abdominal pain, nausea and vomiting, itching and skin rashes, joint pain, dark urine, abnormal blood vessels on the skin, loss of appetite, and pale or gray-colored stools.
People can suffer from viral and drug induced hepatitis as well, so it is important to be clear with your physician regarding what drugs you are taking so you can receive proper diagnosis and treatment. Type 1 and Type 2 of Autoimmune hepatitis are treated with corticosteroids and sometimes immunomodulators like azathioprine (also called Imuran®). Back to top
Although GI complications are a common occurrence in lupus patients, it doesn’t mean that you are doomed to experience all the conditions listed above. Our desire at Molly’s Fund is to not scare you, but to inform, so that those of you who are experiencing any GI issues feel less alone. Lastly, if you think your gut is telling you something, don’t ignore the grumblings. It probably has something important to tell you. So listen up! Back to top
Sources: wikipedia.org/wiki/Human_gastrointestinal_tract, lupus.org/answers/entry/gastrointestinal-system-and-lupus, mayoclinic.org/diseases-conditions/irritable-bowel-syndrome, crohnsandcolitis.com/crohns/what-is-crohns-disease, nlm.nih.gov/medlineplus/jaundice, acutepancreatitis.org
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